Cns

Front 1

RETROGRADE AXONAL TRANSPORT

Retrograde axonal transport is used by what pathologic organisms/toxins?

Back 1

Herpes
Rabies
Polio
Tetanus toxin

Front 2

MCC of viral encephalitis?

Back 2

Coxsackie virus
(late summer early autumn)

Front 3

MC CNS infection in HIV patients?

Back 3

Cytomegalovirus

Front 4

CMV meningitis: common findings- gross and microscopic?
Rx?

Back 4

Gross: Periventricular calcifications
Micro: Basophilic intranuclear inclusions

Rx: Gamcyclovir and foscarnet

Front 5

HSV-1 meningitis gross finding?

Back 5

Hemorrhagic necrosis of temporal lobe
(Herpes= Hemorrhagic)

Front 6

Difference between bacterial and viral meningitides? (lab values)

Back 6

GLUCOSE levels DECREASED in Bacterial meningitides
(<40mg/dl)

Front 7

Viral meningitides associated with decreased CSF glucose?

Back 7

1. Mumps
2. Herpes
3. Choriomeningitis

Front 8

Arbovirus encephalitis: Name the virus.
Reservoir? Vector?

Back 8

1. West nile virus
2. Reservoir- Wild birds(?)
3. Vector- mosquitoes

Front 9

Lymphochoriomeningitis: Vector? Route of transport?

Back 9

1. Vector- Mouse
2. Route- Feco-oral contamination with mice feces

Nuchal rigidity and mental status alteration

Front 10

Post polio syndrome?

Back 10

1. Occurs 15-30 years after infection.

2. Presents with muscle pain, weakness and fatigue.

Front 11

Rabies:
Vector animal?
Inclusion bodies? Describe

Back 11

1. Vector: Raccoon

2. Inclusion bodies- negri bodies
Dark intracytoplasmic eosinophilic bodies.

Front 12

Rabies:
Viral receptor for entry?
Phases of disease?

Back 12

1. Receptor-Acetylcholine receptor

2. Phases-
Prodrome- Fever and paresthesias(at site)
Hydrophobia- Pain due to throat muscle spasm while swallowing
Encephalitis- Associated with negri bodies- seizures, coma, death

Front 13

Rabies: Rx?

Back 13

1. Wash area with quart. NH4 compound.

2. Passive immunization at site

3. Active immunization with diploid human vaccine

Front 14

Rabies: Course of virus through body after infection?

Back 14

1. Replication at site of bite
2. Retrograde axonal transport
3. CNS replication
4. Saliva

Front 15

Lacunar infarcts?

Back 15

1. Microinfarcts <1cm
2. Hyaline arteriolosclerosis
3. Pure motor= Post limb of IC
4. Pure sensory= Thalamus

Front 16

Demyelinating diseases: Name them
(relevant to step1)

Back 16

1. MS
2. GBS
3. PML: Progressive multifocal leukoencepholopathy
4. CPM- Central Pontine Myelinolysis
5. Metachromatic leukodystrophy
6. Charcot Marie tooth disease
7. Postinfectious encephalitis

Front 17

Risk factors for meningitis?

Back 17

1. Undernutrition
2. Otitis media
3. Pneumonia
4. Sickle cell disease
5. Immunodeficiency
6. Craniofacial abnormality

Front 18

Meningitis affects which meningeal layer?

Back 18

PIA

Front 19

Bacterial Meningitides are commonly gram (+ve or -ve)?

Back 19

+ve

Front 20

Imaging modality of choice in strokes?

Back 20

CT with contrast

Front 21

SAH headache patient description?

Back 21

1. "Worst headache of life"
2. OCCIPITAL AREA
3. Nuchal rigidity

Front 22

SAH results from?(cause)
risk factor?

Back 22

1. Berry aneurysm rupture
2. AV malformations(less common)
3. risk factor: hypertension

Front 23

Complications of SAH?

Back 23

1. Hydrocephalus
2. Hemorrhage(recurrence)
3. Permanent neuro deficit

Front 24

Hydrocephalus in SAH: cause?

Back 24

Arachnoid granulations blocked

Front 25

MC site for developing berry aneurysms?
why at that site?

Back 25

Junction of communicating branches with the main branches
1. ACA-ACA(40%)
2. MCA-PCA(20%)
3. PCA-PCA(8%)

Internal elastic lamina and smooth muscle layer absent at these sites

Front 26

TE Stroke rx?

Back 26

1. Thrombolytics within 3 hours
2. Chronic- Antiplatelets, warfarin

Front 27

Psammoma bodies:
Description?
Disease associations?

Back 27

Description- Infarction and calcifications of papillary tips

Diseases-
1. Meningioma
2. Papillary ca of thyroid
3. Cystadenocarcinoma of ovaries
4. Renal CC
5. Mesotheliomas
6. Endometrial adenocarcinoma
7. Prolactinoma
8. Somatostatinoma(pancreas)

Front 28

Creutzfeldt jacob disease: Caused by?

Back 28

Prion proteins- Proteins devoid of DNA and RNA

Front 29

Creutzfeldt jacob disease: modalities of spread?
Gross appearance?

Back 29

1. Corneal transplant
2. Cortical electrodes
3. Infected beef tissue consumption

Gross appearance: "bubble and holes" spongiform cortex

Front 30

Progressive multifocal Leukoencepholopathy: Etiologic agent?

Back 30

Papovavirus (JC virus?)occurs in AIDS- <50cells/mm#3

Front 31

Progressive multifocal Leukoencepholopathy: microscopic findings?

Back 31

Intranuclear inclusions in oligodendrocytes and neurons

Front 32

MC demyelinating disease?

Back 32

MS

Front 33

MCC of optic neuritis?

Back 33

MS

Front 34

MS: Microbial pathogens associated with it?

Back 34

1. HHV6
2. EBV
3. Chl pneumonia

Front 35

MS: HLA association(autoimmune)?

Back 35

HLA-DR2

Front 36

MS: Autoimmune mechanism type?

Back 36

Type IV
1. Helper T cells recognize the myelin basic protein as antigen
2. Cytokines from T cells(TNF-A) activate macrophages
3. Macrophages damage myelin sheath and oligodendrocytes

Front 37

MS: Gross findings?
Microscopic findings?

Back 37

Demyelinated plaques in white matter of brain

CD4 T cells and microglial cells with phagocytic lipids

Front 38

MS: Clinical findings?

Back 38

1. Relapsing and remitting course
2. Optic neuritis- MCC of optic neuritis- blurry vision/loss of vision
3. Sensory dysfunction- Paresthesias, pain/temperature and vibration
4. Motor- UMN- dysfunction
5. Autonomic dysfunction- incontinence, sexual dysfunction, bowel problems
6. SIN- Scanning speech(drunk), Internuclear ophthalmoplegia(MLF demyelination), nystagmus
7. Lhermitte's syndrome- Neck flexion produces an electric shock like pain down the spine

Front 39

MS: CSF findings?

Back 39

1. Leukocyte count- CD4+ cells
2. Gamma-globulins
3. MBP- indicates active demyelination/dz
4. High resolution electrophoresis- Oligoclonal bands on Gamma globulin region(indicates demyelination)

Front 40

MS: Dx? Rx?

Back 40

1. Spinal tap- CSF examination
2. MRI with gadolinium- MOST SENSITIVE

Rx-
1. Acute relapse- methylpredinisone- high dose steroids
2. Chronic- a. Interferon B
b. Natalizumab
c. Azathioprine
d. Cyclophosphamide

Front 41

Central Pontine myelinolysis: Cause?

Back 41

1. Rapid correction of hyponatremia(commonly in alcoholics)
2. Infections- Subacute sclerosing panencephalitis, PML

Front 42

Causative bacteriae for neonatal meningitis?

Back 42

1. Group B strept(+ve
2. E.coli(-ve)
3. Listeria monocytogenes(+ve)

Front 43

Causative bacteria for adult meningitis?

Back 43

1. S. Pneumoniae
2. N.meningitides
3. M.tb
4. T.pallidum(neurosyphilis)

Front 44

L.monocytogenes: source?

Back 44

soft cheese, hot dogs

Front 45

MC cause of neonatal meningitis?

Back 45

Group B strept(S.agalactiae)

Front 46

MC route of spread/source of neonatal meningitis?

Back 46

Maternal vagina

Front 47

Streptococcal meningitis: Rx?

Back 47

1. Empiric: Ampicillin + Cefotaxim
2. Specific: Penicillin/Ampicllin

Front 48

2nd MC cause of neonatal meningitis?

Back 48

E.coli

Front 49

Ecoli meningitis: Rx?

Back 49

1. Empiric: Ampicillin + Cefotaxime
2. Specific: Ceftazidime + Gentamicin

Front 50

MC meningitis in pediatric age group? rx?

Back 50

Neisseria Meningitidis

Ceftriaxone

Front 51

M.tb meningitis: complications?

Back 51

Vasculitis--> infarction
Scarring--> hydrocephalus

Front 52

MCC of adult meningitis? Rx?

Back 52

S.pneumoniae(or N.meningitides?)
Penicillin G/ Ampicillin

Front 53

T.pallidum meningitis(neurosyphilis): types?

Back 53

1. Meningovacuslar: vasculitis causing stroke.
2. General paresis: dementia
3. Tabes dorsalis: Post root ganglia, dorsal columns, argyll robertson pupils(prostitute's pupils)-involvement of pretectal area

Front 54

Rx neurosyphilis?

Back 54

Penicillin G

Front 55

Fungal causes of meningitis?

Back 55

1. Cryptococcus
2. Mucor

Front 56

Fungal meningitis/encephalitis associated with immunocompromised patients?

Back 56

Cryptococcal meningitis.

Front 57

Stain used for Dx cryptococcal meningitis?

Back 57

India ink: budding yeasts visible.

Front 58

2nd MC cause of neonatal meningitis?

Back 58

E.coli

Front 59

Ecoli meningitis: Rx?

Back 59

1. Empiric: Ampicillin + Cefotaxime
2. Specific: Ceftazidime + Gentamicin

Front 60

MC meningitis in pediatric age group? rx?

Back 60

Neisseria Meningitidis

Ceftriaxone

Front 61

M.tb meningitis: complications?

Back 61

Vasculitis--> infarction
Scarring--> hydrocephalus

Front 62

MCC of adult meningitis? Rx?

Back 62

S.pneumoniae(or N.meningitides?)
Penicillin G/ Ampicillin

Front 63

T.pallidum meningitis(neurosyphilis): types?

Back 63

1. Meningovacuslar: vasculitis causing stroke.
2. General paresis: dementia
3. Tabes dorsalis: Post root ganglia, dorsal columns, argyll robertson pupils(prostitute's pupils)-involvement of pretectal area

Front 64

Rx neurosyphilis?

Back 64

Penicillin G

Front 65

Fungal causes of meningitis?

Back 65

1. Cryptococcus
2. Mucor

Front 66

Fungal meningitis/encephalitis associated with immunocompromised patients?

Back 66

Cryptococcal meningitis.

Front 67

Stain used for Dx cryptococcal meningitis?

Back 67

India ink: budding yeasts visible.

Front 68

Rx cryptococcal meningitis?

Back 68

1. Flucanazole (Non AIDS pt)
2. Amphotericin B and flucytosine

Front 69

Meningitis that commonly occurs in diabetics? source? rx?

Back 69

1. Mucor sp.
2. Source: frontal sinus
3. rx: Amphotericin B

Front 70

Meningoencephalitis associated with spread from water? Area of brain affected? rx?

Back 70

1. Naegleria fowleri meningitis (meningoencephalitis)- protozoal
2. Frontal lobe
3. Amphotericin B

Front 71

Protozoal CNS infections: name the organisms?

Back 71

1. Naegleria fowleri(meningoencephalitis)
2. Trypanosoma gambiense/rhodesiense(encephalitis)

Front 72

Sleeping sickness: causative agent? transmitting agent?

Back 72

1. Trypanosoma gambiense/ rhodiense(encephalitis)
2. Tsetse fly (Glossina)

Front 73

Sleeping sickness: Course of organism through the body?

Back 73

1. Blood/lymphatics
2. Posterior cervical LNs: Winterbottom sign
3. Encephalitis

Front 74

Trypanosomal encephalitis: clinical finding? (unique)

Back 74

Somnolescence : hence the name- due to mediators released from organism

Front 75

MCC death in sleeping sickness?

Back 75

Starvation

Front 76

Sleeping sickness: Dx? Rx?

Back 76

Dx- 1. Characterisitic increase in IgG early in dz
2. Detect organism in blood/ CSF
3. Serology

Rx-
Early stage- Pentamidine
Encephalitis stage- melarsoprol

Front 77

Most common CNS SOL in AIDS?

Back 77

Toxoplasma gondii encephalitis

Front 78

Cysticercosis: causative agent? transmitting agent?

Back 78

Taenia solium
Pigs

Front 79

Cysticercosis: Course of organism through body? rx?

Back 79

Cycle: Patient ingests food containing eggs --> develops into larval form --> invades brain --> calcified cysts --> seizures

Rx: albendazole + dexamethasone

Front 80

T.gondii encephalitis: part of brain affected? rx?

Back 80

Parts: Basal ganglia
Rx: pyrimethamine+sulfadiazine+ dexamethasone

Front 81

Adrenoleukodystrophy: enzyme defect? effect? pattern of inheritance?

Back 81

Defect involving b-oxidation of fatty acids.(?)

Effect:
1. Demyelination
2. Adrenal insufficiency.

Inheritance: XR

Front 82

Metachromatic leukodystrophy: enzyme defect? fn of enzyme?

Back 82

Enzyme: ASA
Fn: Hydroxylation of sulfate glycosphingolipids.: accumulation of sulfatides

Front 83

Metachromatic leukodystrophy: Stain? inheritance pattern?

Back 83

Alcian blue and PAS
AR

Front 84

Krabbe's disease: enzyme defect? microscopic appearance?

Back 84

Enzyme defect: Galactocerebroside b-galactocerbrosidase deficiency

Microscopic appearance: Multinucleated histocytic cells (globoid cells)

Front 85

Alzheimer's disease: types?

Back 85

1. Sporadic: Late onset
2. Sporadic: Early onset
3. Familial: Early onset

Front 86

Trisomy associated with alzheimer's? pathology?

Back 86

1. Trisomy 21: Down's
2. Chromosome 21 encodes for APP

Front 87

Alzheimer's disease: Pathology?

Back 87

1. APP metabolized by sectretase alpha---> inactive fragments(cannot be converted to AB)
APP metabolized by secretes B or gamma --> fragments converted to AB--> increased phosphorylation by GSK(activated by inactivation of wingless integration pathway)
phosphorylated AB protein--> neurotoxicity(induces neuronal apoptosis)--> alzheimer's
2. Tau protein phosphorylation by GSK produces neurofibrillary tangles(visualized by silver stain)- NF have altered structure--> cluster into fibres
NF tangles--> neuronal death
3. Wingless integration pathway defect: required for inhibiting GSK--> increased GSK activity--> hyperphosphorylation
4. Pin 1 enzyme= prolyl isomerase removes phosphate molecules from NF. restoring its original structure--absent in some cases
5. Apolipoprotein gene E: allele epsilon 4 codes for a product that fails to eliminate AB from brain
6. Insulin degrading enzyme- degrades insulin and AB.
in type II DM-- increased insulin levels decreases Insulin degrading enzyme-->more AB deposition

GSK= glycogen synthase kinase

Front 88

Alzheimer's disease: Role of secretase alpha?

Back 88

APP--> metabolized into inactive products not convertible to Amyloid. therefore protective

Front 89

Alzheimer's disease: Role of secretase beta/gamma?

Back 89

APP--> metabolized into fragments convertible into AB. therefore AD.

Front 90

Alzheimer's disease: role of Glycogen Synthase Kinase?(GSK)

Back 90

Hyperphosphorylation of:
1. Amyloid beta protein--> signals neuronal apoptosis
2. Tau proteins-->NF tangles(altered tau protein)-->neuronal death

Front 91

Normal function of tau protein? Role in Alzheimer's dz?

Back 91

tau protein: scaffolding - maintains neuron structure

In Alzheimer's dz: increased phosphorylation of tau proteins-->NF tangles--> neuronal toxicity

Front 92

Alzheimer's disease: role of pin-1 enzyme?

Back 92

Pin-1 enzyme- aka prolyl isomerase
strips excess phosphate from NF--restoring its original shape and structure

Front 93

AD: AB protein damages neurons - parts of the cortex involved?

Back 93

1. Medial temporal lobe
2. Frontal cortex: entorhinal cortex
3. Hippocampus

Front 94

Wingless integration pathway: Function? role in alzheimer's disease?

Back 94

Function: neuronal development during embryogenesis and normal functioning
Inhibits GSK

Front 95

Stains used to detect beta amyloid?

Back 95

Congo red: apple green birefringence with polarization

Front 96

Sporadic early onset AD: genetic defect?

Back 96

apolipoprotein gene E. allelle epsilon 4
chromosome (19?)
codes for product that cannot eliminate AB from brain

Front 97

Diabetes type associated with Alzheimer's disease?

Back 97

Type II
Insulin increment reduces insulin degrading enzyme levels also needed for degradation of AB--> accumulates--> Alzheimers Dz

Front 98

Alzheimer's dz: Gross findings?

Back 98

1. Cerebral atrophy- frontal, parietal, temporal
2. Ventricular dilation (hydrocephalus ex vacuo)

**Occipital lobe- spared in AD**

Front 99

Alzheimer's dz: Microscopic findings?

Back 99

1. NF tangles- silver stain
2. Senile plaques:
Core AB(congo red) surrounded by
Neuronal processes
Microglial cells
Astrocytes
3. Amyloid angiopathy- weakening of vessels--> hemorrhage.

Front 100

Alzheimer's diz: confirmatory dx?

Back 100

Post-mortem examination. Senile plaques and NF tangles

Front 101

Alzheimer's dz: early symptoms?

Back 101

1. Short term memory loss- hippocampus
2. Loss of smell- entorhinal cortex dysfunction

Front 102

Common cause of death in Alzheimer's dz pts?

Back 102

Infections: bronchopneumonia
(lack of hygiene)

Front 103

Alzheimer's dz: lobe spared?

Back 103

Occipital lobe

Front 104

Diseases associated with NF tangles? visualized by (stain)?

Back 104

1. Alzheimer's dz
2. Huntington's dz
3. Niemann-Pick


Visualized by silver stain

Front 105

Alzheimer's dz: Rx?

Back 105

Cholinesterase inhibitors
Memantine- glutamate receptor blockers

Front 106

Parkinsonism: Causes?

Back 106

1. Encephalitis
2. Ischemia
3. CO poisoning- necrosis of globus pallidus
4. Wilson's disease
5. MPTP- derived from meperidine
6. Antipsychotics- Phenothiazines

Front 107

Parkinsonism: Pathophysiology?

Back 107

Depigmentation and degeneration of neurons: d/t loss of dopamine

Front 108

Parkinsonism: Microscopic features?

Back 108

Intracytoplasmic eosinophilic bodies: Lewy bodies.

Front 109

Parkinsonims: What are Lewy bodies?

Back 109

Intracytoplasmic eosniophilic bodies
Ubiquinated damaged neurofilaments.

Front 110

Intracytoplasmic eosinophilic bodies: Associated diseases?

Back 110

1. Lewy bodies: Parkinson's dz
2. Negri bodies: Rabies

Front 111

Parkinsonism: Clinical features?

Back 111

1. Bradykinesia
2. Rigidity: cogwheel
3. Tremors: resting, pill rolling- between thumb and index finger
4. Expressionless face: poker face
5. Shuffling gait
6. Blepharospasm
7. Seborrheic dermatitis.
8. Dementia

Front 112

Parkinsonism: treatment?

Back 112

1. Levodopa
2. Carbidopa
3. MAO inhibitors
4. Bromocriptine
5. Pergolide

Front 113

Parkinsonism: Drugs that worsen disease?

Back 113

1. Neuroleptics
2. Antiemetics
3. MAO inhibitors

Front 114

Huntington's dz: inheritance pattern?

Back 114

AD

Front 115

Huntington's dz: genetic defect? pathology?

Back 115

CAG(codes for glutamine) repeats on Chromosome 4(Fab the hunter)

Atrophy of striatal neurons:
1. Caudate,
2. Putamen,
3. Globus pallidus

Front 116

Huntington's dz: clinical findings?

Back 116

Chorea
Oculomotor defects
Parkinsonism
Depression
(COPD)

Front 117

Huntington's dz: Dx?

Back 117

Genetic testing
CT, MRI- atrophy of caudate and putamen

Front 118

Friedrich's ataxia: inheritance pattern? genetic defect/pathology?

Back 118

AR
GAA repeat sequence- frataxin deficiency- impaired mitochondrial Fe homeostasis-->apoptosis
(FFFF)
(Friedrich's ataxia : Frataxin defect Fe homeostasis F*****)

Front 119

MCC genetic ataxic disorder?

Back 119

Friedrich's ataxia

Front 120

Friedrich's ataxia: sites affected?

Back 120

1. Dorsal root ganglia
2. Dorsal columns
3. Spinocerebellar tracts
4. Corticospinal tracts
5. Large peripheral nerves

Front 121

Friedrich's ataxia: disease associations?

Back 121

1. Hypertrophic cardiomyopathy
2. Type I DM

Front 122

Friedrich's ataxia: clinical findings?

Back 122

1. Ataxia
2. Loss of vibration and proprioception
3. Loss of deep tendon reflexes-INITIALLY at ANKLES
4. Muscle weakness- L. Extr

Front 123

Friedrich's ataxia: Dx?

Back 123

MRI- SC atrophy
Gene testing

Front 124

Lou Gehrig's dz: (ALS) Genetic defect?

Back 124

Mutation on chromosome 21: Defective superoxide dismutase 1--> superoxide free radical injury

Front 125

Lou Gehrig's dz: Clinical findings?

Back 125

1. UMN signs: (Lower extrm)
2. LMN signs: (Upper extrm)
3. Atrophy of intrinsic muscles of hand
Intact autonomic and sensory functions.

Front 126

Lou Gehrig's dz: Earliest clinical finding?

Back 126

Atrophy of intrinsic muscles of hand.

Front 127

Lou Gehrig's dz: Dx?
Rx?

Back 127

Electromyography and nerve conduction studies

Riluzole: glutamate antagonist

Front 128

Lou Gehrig's disease: MCC of death?

Back 128

Respiratory muscle paralysis

Front 129

Werdnig Hoffmann dz?

Back 129

LMN dz in children.

Front 130

Wilson's dz: inheritance pattern? Pathology?

Back 130

Autosomal recessive
Defective incorporation of Cu into ceruloplasmin.--> increased free Cu in blood and cirrhosis

Front 131

Wilson'd dz: structures affected in CNS?

Back 131

1. **Globus pallidus**
2. Putamen

Front 132

CNS signs in wilsons dz?

Back 132

1. Parkinsonism
2. Chorea
3. Dementia

Front 133

Acute intermittent porphyria: enzyme defect?
Inheritance pattern?

Back 133

1. Uroporphobilinogen synthase/ porphobilinogen deaminase
Therefore increase in PBG and d-ALA--> neurotoxic

2. Inheritance: AD

Front 134

Urine color change in acute intermittent porphyria? Reason?

Back 134

Light exposure produces port wine color. (window sill test)'
PBG--> porphobilin(colored product) on light exposure

Front 135

Acute intermittent porphyria: compound associated with disease?

Back 135

Porphobilin

Front 136

Acute intermittent porphyria: Drugs that worsen dz? how?

Back 136

Barbiturates
Alcohol
(Drugs that enhance P450) enzyme activity.

ALA: Rate limiting enzyme of heme synthesis
In AIP heme synthesis decreases--> increased activity of ALA synthase--> more porphobilin--> attack precipitated
P450 inducing drugs also induce enhanced ALA synthase activity

Front 137

AIP: Clinical findings?

Back 137

1. Painful abdomen- acute abdomen
2. Psychosis
3. Peripheral neuropathy
4. Dementia
(PPPD)

Front 138

Severe combined degeneration of spinal cord: pathology?

Back 138

Deficiency of B12--> methyl malonyl coA mutase cannot function--> incorporation of methylmalonic acid--> neuropathy
1. Degeneration of dorsal columns and corticospinal tracts.
2. Dementia
3. Peripheral neuropathy.

Front 139

CNS conditions associated with dementia?

Back 139

1. Alzheimer's dz
2. Neurosyphilis
3. Parkinsonism
4. Wilson's dz
5. AIP
6. B12 deficiency

Front 140

Alcohol abuse: CNS findings?

Back 140

1. Cortical atrophy
2. Cerebellar atrophy
3. Wernicke-Korsakoff syndrome(thiamine deficiency)- maxillary body hemorrhage
a. Wernicke's: REVERSIBLE- Confusion, ataxia, nystagmus, ophthalmoplegia
b. Korsakoff's: IRREVERSIBLE advanced stage- Amnesia, confabulation, hallucinations
Rx- thiamine supplement

Front 141

MC primary CNS tumors in adults?

Back 141

#1. Glioblastoma multiforme(high grade astrocytoma)
#2. Meningioma
#3. Ependymoma

Front 142

MC primary CNS tumors in children?

Back 142

#1. Cystic cerebellar astrocytoma
#2. Medullobastoma
#3. Brain stem glioma

Front 143

Glioblastoma multiforme: GBM: Cell affected?

Back 143

Astrocyte- high grade

Front 144

Glioblastoma multiforme: MC site affected.

Back 144

Corpus callossum

Front 145

Glioblastoma multiforme: MC organ to get metastasized?

Back 145

None(Rarely metastasizes)

Front 146

Glioblastoma multiforme: Gross findings?

Back 146

1. Hemorrhagic necrosis
2. Multiple areas of necrosis
3. Cystic degeneration

MC site: corpus callossum

Front 147

Astrocytoma: Common sites of involvement- adults and children

Back 147

Adults: Frontal lobe
Children: Cerebellum

Front 148

MC benign tumor in adults?

Back 148

Meningioma

Front 149

Meninioma: More common in : Men/women? why?

Back 149

Women: tumors have estrogen receptor

Front 150

Meningioma: Sites affected?

Back 150

1. Parasagittal location
2. Olfactory groove
3. Lesser wing of sphenoid

Front 151

Meningioma: Disease associations.

Back 151

1. Neurofibromatosis
2. Radiation exposure
3. New onset seizures

Front 152

CNS tumor associated with radiation exposure?

Back 152

Meningioma

Front 153

Meningioma: Gross features.

Back 153

Firm mass- Indents surface of brain.
Infiltrates the overlying bone- increases bone density.

Front 154

Meningioma: Microscopic features?

Back 154

Psammomma bodies in meningeal cells. (calcified swirling bodies)

Front 155

Ependymoma: Malignant/ benign? MC sites?

Back 155

Benign
Adults: Cauda equina
Children: fourth ventricle

Front 156

Medulloblastoma: Site of origin? Metastasis to?

Back 156

Cerebellum- External granular cell layer
Fourth ventricle

Front 157

Oligodendroglioma: Benign/malignant? Common site?

Back 157

Benign tumor
Frontal lobe tumor- calcified.

Front 158

CNS lymphoma: Type? Association/s?

Back 158

Type- Hodgin's lymphoma
Associated with-
AIDS
EBV mediated B cell lymphoma

Front 159

MC malignancy of brain?

Back 159

Metastatic

Front 160

Sites associated with CNS metastasis?

Back 160

#1. Lungs
#2. Breast
#3. Skin
#4. Kidney
#5. GIT

Front 161

Peripheral neuropathies.

Back 161

1. Demyelination related- all

2. DM

3. Toxins-
a. alcohol
b. heavy metals
c. diphtheria

4. Idiopathic Bell's palsy- CN VII
a. Herpes Simplex- MC
b. HIV
c. Sarcoidosis
d. Lyme dz
e. Pregnancy

5. Drugs-
a. Vincristine
b. Hydralazine
c. Phenytoin

6. Vitamins-
a. Thiamine
b. B12
c. Pyridoxine

Front 162

MCC of all peripheral neuropathies?

Back 162

DM

Front 163

Rx of peripheral neuropathies?

Back 163

1. Antiseizures- Gabapentin, carbamazepine, phenytoin
2. Lidocaine
3. TCAs-
a. Amitriptyline
b. Nortriptyline

Front 164

MC hereditary peripheral neuropathy? Inheritance pattern?

Back 164

Charcot Marie Tooth dz
Autosomal dominant

Front 165

Charcot Marie Tooth dz: MC nerve involved?

Back 165

Peroneal nerve
Atrophy of lower legs--> inverted bottle appearance

Front 166

Inverted bottle appearance of legs seen in____?

Back 166

Charcot Marie Tooth dz
(d/t atrophy of muscles of lower leg)

Front 167

MC acute peripheral neuropathy?

Back 167

GBS

Front 168

MCC of Acute flaccid paralysis?

Back 168

GBS

Front 169

GBS: Predominantly motor/sensory?

Back 169

Motor

Front 170

GBS: preceding infections?

Back 170

1. Mycoplasma Pneumonia
2. Campylobacter Jejuni
3. HIV
4. EBV
5. CMV
6. Influenza


1. Mycoplasma Pneumonia
2. Campylobacter Jejuni
3. HIV
4. EBV
5. CMV
6. Influenza

1. Mycoplasma Pneumonia
2. Campylobacter Jejuni
3. HIV
4. EBV
5. CMV
6. Influenza

2 bacterial and 4 viral

Front 171

GBS: Course of muscle weakness?

Back 171

**Rapidly progressive ascending motor weakness**
Starts in proximal muscles eventually distal muscles
Areflexia
"Glove stocking" paresthesias/anesthesia

Front 172

GBS: Common cause of death?

Back 172

Respiratory failure due to failure of muscles of ventilation

Front 173

GBS: Dx/ Laboratory findings?

Back 173

1. Spinal tap- Increased CSF protein- Oligoclonal band on high resolution electrophoresis

2.Electromyography and nerve conduction studies

Front 174

GBS: Rx?

Back 174

IVIG
Mechanical ventilation

Front 175

Diabetes Mellitus(DM): Peripheral neuropathy - reason?

Back 175

Osmotic damage to Schwann cells

Front 176

Bell's palsy: Clinical findings- LMN-UMN difference?

Back 176

LMN- Ipsilateral upper and lower face involvement
UMN- C/l lower face involved and sparing of upper half of face

Front 177

CNS/PNS: Benign tumors?

Back 177

Ependymoma
Meningioma
Schwannoma

Front 178

Schwannoma/neurilemoma: Cranial Nerves generally involved?

Back 178

1. CN V
2. CN VII

Front 179

Acoustic neuroma: CN involved- type of tumor? location?

Back 179

1. Schwannoma
2. Cerebellopontine angle

Front 180

Acoustic neuroma: features?

Back 180

1. Located at cerebellopontine angle
2. Encapsulated
3. Unilateral- except those associated with NF-2(B/l)
4. Alternating dark and light areas on microscope

Front 181

NF-2 associated acoustic neuroma- clinical features?

Back 181

1. Tinnitus
2. Sensorineural deafness
3. Sensory changes in CN V distribution tumor compression on V

Front 182

Ulnar nerve injury:
Nerve roots of ulnar n?
Commonly associated fx?
Clinical finding?

Back 182

1. C8-T1
2. Fx of medial epicondyle of humerus
3. Claw hand- Interosseous muscle affected

Front 183

Radial nerve injury:
Nerve root?
Associated fx?
Clinical finding?

Back 183

1. C5-T1
2. Midshaft fx of humerus
3. Wrist drop

Front 184

Axillary nerve
Nerve root?
Associated fx?
Clinical finding?

Back 184

1. C5-C6
2. Fx of surgical neck of humerus/anterior dislocation
3. Loss of arm abduction(deltoid muscle paralysis)

Front 185

Median nerve:
Nerve root?
associated fx?
C6-T1

Back 185

C6-T1
Associated conditions:
1. Rheumatoid arthritis
2. Pregnancy
3. Overuse of hands
4. Hypothyroidism
5. Amyloidosis
6. Supracondylar fx of humerus

Front 186

Median nerve compression/ carpal tunnel signs/symtoms?

Back 186

1. Pain/paresthesias/ numbness over-
a. Thumb
b. Index finger
c. Middle finger
d. Radial side of fourth finger

2. Thenar atrophy- ape hand, difficulty opposing thumb


3. Tinel's sign- Pain produced by tapping median nerve (tap with Tinel's)

4. Phalen's sign- Pain produced by flexion of wrist for 1 minute (Flex with Phanel's)


Dx- nerve conduction studies, EMG

Front 187

Common peroneal nerve:
nerve roots?
Associated fx?
Clinical findings?

Back 187

L4-S2
common peripheral neuropathy
lead poisoning
Fx neck of fibula
cast tightness

1. Loss of ankle reflex
2. loss of foot eversion- weakening of peroneus longus and brevis
3. loss of dorsiflexion- weakening of tibialis anterior- foot drop, high stepping/slapping gait
4. loss of toe extension- weakening of extensor digitorum longus and hallucis longus
5. In all EQUINOVARUS deformity

Front 188

Erb duchene palsy? Nerve roots involved?

Back 188

C5, C6
"Waiter's tip deformity"

Front 189

Cerebral edema: types? causes?

Back 189

1. Intracellular:
a. Dysfunctional Na/K pump(from global hypoxia)
b. Hyponatremia(SIADH)

2. Extracellular:
a. Inflammation: meningitis, encephalitis
b. Metastasis
c. trauma
d. lead poisoning

Front 190

Head trauma: effect on respiration? how does this help?

Back 190

Respiratory alKalosis--> vasoConstriction--> decreased vessel permeability

(In aciDosis--> vasoDilation. in acidosis, K channel activity increases--> K moves out--> hyper polarizes cell--> sm relaxation--> vasodilation)

Front 191

Signs of increased intracranial pressure?

Back 191

1. Papilledema
2. Headache
3. Projectile vomiting
4. Sinus bradycardia
5. Hypertension
6. Herniation

Front 192

Pseudotumor cerebri? MC individuals affected/Risk factors?

Back 192

Vit A excess/ All-trans retinoic acid-(used in rx of AML)
2. hypothyroidism
3. Cushing's disease
4. Isotretinoin
5. Tamoxifen

Front 193

Pseudotumor cerebri: pathogenesis? clinical findings?

Back 193

Decreased CSF absorption in the arachnoid granulations
1. Findings in raised ICP
2. Rhythmic sounds in both ears
3. Diplopia
4. Blurry vision

Front 194

Pseudotumor cerebri: Dx? Rx?

Back 194

Dx:
1. MRI: flattening of posterior globe
2. CSF pressure> 300mm H2O(normally 70-180 mm go H20)
3. Decreased CSF protein

Rx:
1. Medical:
a. Carbonic anhydrase inhibitor,
b. Systemic corticosteroids
2. Surgical:
a. Lumboperitoneal shunts,
b. Optic nerve sheath fenestration

Front 195

Cerebral herniation: results as a complication of____?

Back 195

Complication of raised ICP

Front 196

Cerebral herniation: Name em. Parts of brain herniating associated and openings.

Back 196

1. Subfalcine: Cingulate gyrus under falx cerebri
2. Uncal: Medial portion of temporal lobe through tentorium cerebelli
3. Tonsillar: Cerebellar tonsils herniate into foramen magnum

Front 197

Complications associated with:
Subfalcine
Uncal
Tonsillar herniation.

Back 197

1. Subfalcine: compression of ACA
2. Uncal: Compression of midbrain(III nerve nuclei--> Eyes deviated down and out+ dilated pupils) and PCA
3. Tonsillar: Cardiorespiratory arrest.

Front 198

Hydrocephalus: types? respective causes?

Back 198

Types:
1. Communicating:
a. Increased CSF production: choroid plexus papilloma
b. Defect in reabsorption of CSF- Postmeningitic scarring

2. Non-communicating:
1. Stricture in aqueduct of sylvius--> Paralysis of upward gaze(Parinaud's syndrome)
2. Colloid cyst in the 3rd ventricle
3. Tumor in 4th ventricle- ependymoma, medulloblastoma
4. Scarring at the base of the brain: Tb meningitis

Front 199

Hydrocephalus: Clinical findings?

Back 199

1. Signs of raised ICP
2. In children: enlarged head circumference
in adults: no change in size

Front 200

Hydrocephalus ex-vacuo?

Back 200

Dilated brain ventricles with reduced brain mass.

Front 201

Normal pressure hydrocephalus: symptom complex? causes?

Back 201

Dilated ventricles+ Wide based gait, Urinary incontinence, Dementia
(WWW- wet wobbly whacky)

causes-
1. Idiopathic
2. Secondary:
a. Prior SAH
b. Prior Tumor
c. Prior IC Sx

Front 202

Normal pressure hydrocephalus: pathogenesis?

Back 202

Ventriculomegaly
Wide based gait and urinary incontinence: due to sacral motor fibre stretching
Dementia: due to stretching of limbic fibres.

Front 203

Normal pressure hydrocephalus: Dx? rx?

Back 203

MRI: ventriculomegaly and sulcal atrophy
Lumbar puncture: Large volume CSF removed--> improved symptoms


Rx:
Ventriculoperitoneal shunt
Ventriculoatrial shunt

Front 204

Neural tube defects: Pathogenesis?

Back 204

1. Failure of closure of lateral folds of neural plate
2. Rupture of closed NT.

Front 205

Serum marker associated with NTD?

Back 205

Alpha feto protein in serum or amniotic fluid

Front 206

NTDs: types?

Back 206

1. Anencephaly
2. Spina bifida occulta
3. Meningocele
4. Meningomyelocele

Front 207

Anencephaly: Defect? Clinical finding?

Back 207

Complete absence of brain
Polyhydramnios
Raised AFP levels

Front 208

Spinca bifida occuta: Defect? clinical finding?

Back 208

Failure of closure of post vertebral arch
Tuft of hair in skin over L5-S1

Front 209

Meningocele: Defect? MC location?

Back 209

Spina bifida with cystic mass containing meninges
Lumbosacral region

Front 210

Meningomyelocele: defect? MC location?

Back 210

Spina bifida with cystic mass containing meninges and spinal cord
lumbosacral area

Front 211

Arnold Chiari malformation: Pathology? hydrocephalus- type?

Back 211

Herniation of medulla and cerebellar vermis through foramen magnum
Non communicating hydocephalus

Front 212

Arnold Chiari malformation: Associations? Rx?

Back 212

1. Syringomyelia
2. Meningomyelocele

Rx: Decompression sx

Front 213

Dandy waker malformation: defect? hydrocephalus-type? rx?

Back 213

1. Partial/complete absence of cerebellar vermis
2. Cystic dilation of 4th ventricle
3. Non communicating hydrocephalus

rx- shunt

Front 214

Syringomyelia: Pathology/ Defect? associations?

Back 214

Syrinx (fluid filled cavity) within the cervical spinal cord.-->cervical cord enlargement-->cavity expansion causes spinal tract degeneration.
Associated with Arnold- Chiary malformation type II
Obstruction to the outflow to the CSF.

Front 215

Syringomyelia: clinical findings?

Back 215

1. Lateral spinothalamic tract: Loss of pain and temperature B/l at the site of lesion--generally cervical(hands involved)

2. Corticospinal tract: Atrophy of intrinsic muscles of hands(c- ALS: no sensory loss)

Front 216

Syringomyelia: Dx? Rx?

Back 216

Dx: MRI: dilated syrinx
rx: drainage of syrinx

Front 217

MC phakomatoses?

Back 217

NF

Front 218

Neurofibromatosis: types?

Back 218

Type 1: Peripheral type
Type 2: Central type

Front 219

Neurofibromatosis type 1: genetic defect? Inheritance pattern?

Back 219

Chromosome 17: neurofibromin- defective
AD

Front 220

Neurofibromatosis type 2: genetic defect? Inheritance pattern?

Back 220

Chromosome 22: merlin - defective
AD

Front 221

NF-1: Important associations/Clinical findings?

Back 221

1. Cafe au lait: 100% incidence in children <2yrs
2. Optic glioma: (astrocytoma)
3. Lisch nodules: Hamartomas of the iridae
4. Axillary and inguinal freckling
5. Scoliosis
6. Plexiform neurofibroma
7. Cutaneous/subcut. neurofibromas: DO NOT occur on soles and palms, increase in size with age
8. Pheochromocytoma
9. Wilm's tumor
10. CML
11. Neurodevelopmental problems

Front 222

NF-2: Important associations/Clinical findings?

Back 222

1. B/l acoustic neuromas- benign, SN hearing loss
2. Meningiomas
3. Spinal schwannomas
4. Juvenile cataract

Front 223

NF syndromes: Dx? Rx?

Back 223

Dx: genetic testing
Rx: Sx

Front 224

Tuberous sclerosis: Inheritance pattern? Clinical findings?

Back 224

AD disorder
Clinical findings:
Triad-
1. MR
2. Seizures
3. Ash leaf lesions/angiofibromas

Front 225

Skin lesions in tuberous sclerosis?

Back 225

1. Angiofibromas: Adenoma sebaceum
2. Ash leaf lesion: hypo pigmented skin lesions aka shagreen's patch

Front 226

Tuberous sclerosis: tumors associated?

Back 226

1. Angiomyolipomas: kidneys
2. Rhabdomyomas
3. Astrocyte proliferation in subependyma

Front 227

Tumor highly predictive of tuberous sclerosis?

Back 227

Rhabdomyoma

Front 228

Sturge Weber syndrome: Inheritance pattern?

Back 228

1. Sporadic
2. Mosaicism

Front 229

Sturge Weber syndrome: associations?

Back 229

Vascular malformation of face- area of distribution of trigeminal nerve.
Ipsilateral AV malformations in meninges.

Front 230

Cerebral contusions: common sites of involved?

Back 230

Coup injury: cerebellum
counter coup injury: frontal and temporal lobes

Front 231

Acute epidural hematoma:
Commonly involved fx?
vessel rupture associated?
complication?
Dx?
rx?

Back 231

Fx : Temporoparietal bone fx-->
middle meningeal artery rupture(vessel lies between dura and inner table of bone)
complication: raised ICP.--> herniation
dx: CT - hematoma does not cross suture line
rx: burr holes.

Front 232

Subdural hematoma
Vessel associated?
Pathogenesis?
Causes?
Risk factors?
Clinical findings?
Dx?
Rx?

Back 232

Venous bleed

Tearing of bridging veins b/w brain and dural sinuses (d/t loss of brain mass--> traction on the veins)

Causes:
1. Blunt trauma
2. Anticoagulation
3. Hemophilia
4. Child abuse- shaken baby syndrome

Risk factors:
1. Elderly
2. Alcoholics

Clinical finidings:
1. Fluctuating levels of consciousness.
2. Herniation
3. Dementia: from chronic blood clot

Dx: CT head

Rx: Burr holes

Front 233

Global hypoxic injury: causes? complications?

Back 233

Causes-
1. Cardiac arrest
2. Hypovolemic shock
3. Chronic CO poisoning

** Repeated episodes of hypoglycemia(effect similar to hypoxia)**

Complications-
1. Cerebral atrophy- Apoptosis in areas 3,5,6 of cerebral cortex-->laminar necrosis
2. Watershed infarcts- Jn of ACA and MCA
3. CVA

Front 234

What are Red neurons?

Back 234

Apoptotic neurons (from hypoxia)

Front 235

Amaurosis fugax?

Back 235

Temporary loss of vision due to embolization to bifurcation of the retinal arteries.

Front 236

Strokes: peak age group? types?

Back 236

types-
1. Ischemic- atherosclerotic/embolic
2. Hemorrhagic
3. SAH
4. Lacunar strokes

Front 237

MC type of stroke?

Back 237

atherosclerotic

Front 238

Sites of atherosclerotic strokes?

Back 238

1. MCA
2. Internal carotid bifurcation

Front 239

Atherosclerotic strokes: Gross findings? microscopic findings?

Back 239

1. Pale infarcts: periphery of cortex- wedge shaped
2. Swelling of brain- loss of demarcation of gray and white matter
3. Gliosis- reaction to injury- microglial cells
4. Cystic area- from liquefactive necrosis

Front 240

Arcus Senilis: identify. location? significance?

Back 240

Gray opaque ring: Cholesterol deposits in corneal stroma
Cornea- more commonly corneal margin
May indicate hypercholesterolemia if pt<50 yrs and smoker

Front 241

Common cause of conjunctivitis in neonates?

Back 241

Causative organisms? Rx?
1. Ophthalmia neonatorum
2. i. N. gonorrhea
ii.C.trachomatis
rx-
N.gonorrhea: ceftriaxone
C.trachomatis: erythromycin

Front 242

MCC of bacterial conjunctivitis?

Back 242

S. aureus

Front 243

Bacterial conjunctivitis: causative bacteriae? Clinical findings? rx?

Back 243

#1. S.aureus
#2. S.pneumonia
#3. H.Influenza
**pain but no blurry vision**
rx- Gatifloxacin

Front 244

Viral conjunctivitis: causative viridae?

Back 244

1. Adenovirus
2. HSV-1

Front 245

HSV-1 conjunctivitis: complication?

Back 245

Dendritic ulcers detected by fluorescein stain

Front 246

Adenovirus clinical findings?

Back 246

"Pink Eye" (MC viral cause of conjunctivitis?)
Periauricular lymphadenopathy

Front 247

Allergic conjunctivitis: rx?

Back 247

rx: antihistaminics, olapatidine-mast cell stabilizer

Front 248

Acanthamoeba infection: Site? patients affected? rx?

Back 248

Keratoconjunctivitis- severe
Patients who do not cleanse their contact lenses.
rx: propamidine+ polymyxin/neomycin/gramicidin

Front 249

Stye: MC organism? Rx?

Back 249

S.aureus
rx: hot packs + dicloxacillin

Front 250

Chalazion: ? rx?

Back 250

Granulomatous inflammation of the meibomian glands in eyelid
self resolving- 2months
rx-intralesional corticosteroid injection/ sx removal

Front 251

Orbital cellulitis: Source? causative agents?

Back 251

1. Secondary to sinusitis: ethmoiditis
2. i. S. pneumonia
ii. H.influenza

Front 252

Orbital cellulitis: clinical findings? rx?

Back 252

1. Fever,
2. Proptosis
3. Periorbital swelling
4. Ophthalmoplegia
5. <normal retinal examination>

Front 253

Orbital fx: characteristic finding? complications?

Back 253

1. Raccoon eyes- edema and ehymosis of eyelids and periorbital region
2. Complications-
i. Prolapse of orbital content maillary sinus- sunken eye
ii. Infraorbital nerve compression

Front 254

Pterygium? cause? rx?

Back 254

Raised triangular thickened conjunctiva on nasal side
Exposure to wind/sun/sand
rx- sx removal

Front 255

Pinguelcula? location? rx?

Back 255

Conjunctival degeneration.
Location: jn of conjunctiva and cornea- nasal side
rx- none needed

Front 256

Optic neuritis: Causes? rx?

Back 256

#1. Multiple sclerosis
#2. Methanol poisoning
rx- corticosteroids

Front 257

Central retinal artery occlusion: causes?

Back 257

1. Embolization from ipsilateral carotid and ophthalmic artery
2. Giant cell temporal arteritis

Front 258

Acanthamoeba infection: Site? patients affected? rx?

Back 258

Keratoconjunctivitis- severe
Patients who do not cleanse their contact lenses.
rx: propamidine+ polymyxin/neomycin/gramicidin

Front 259

Stye: MC organism? Rx?

Back 259

S.aureus
rx: hot packs + dicloxacillin

Front 260

Chalazion: ? rx?

Back 260

Granulomatous inflammation of the meibomian glands in eyelid
self resolving- 2months
rx-intralesional corticosteroid injection/ sx removal

Front 261

Orbital cellulitis: Source? causative agents?

Back 261

1. Secondary to sinusitis: ethmoiditis
2. i. S. pneumonia
ii. H.influenza

Front 262

Orbital cellulitis: clinical findings? rx?

Back 262

1. Fever,
2. Proptosis
3. Periorbital swelling
4. Ophthalmoplegia
5. <normal retinal examination>

Front 263

Orbital fx: characteristic finding? complications?

Back 263

1. Raccoon eyes- edema and ehymosis of eyelids and periorbital region
2. Complications-
i. Prolapse of orbital content maillary sinus- sunken eye
ii. Infraorbital nerve compression

Front 264

Pterygium? cause? rx?

Back 264

Raised triangular thickened conjunctiva on nasal side
Exposure to wind/sun/sand
rx- sx removal

Front 265

Pinguelcula? location? rx?

Back 265

Conjunctival degeneration.
Location: jn of conjunctiva and cornea- nasal side
rx- none needed

Front 266

Optic neuritis: Causes? rx?

Back 266

#1. Multiple sclerosis
#2. Methanol poisoning
rx- corticosteroids

Front 267

Central retinal artery occlusion: causes?

Back 267

1. Embolization from ipsilateral carotid and ophthalmic artery
2. Giant cell temporal arteritis

Front 268

Central retinal artery occlusion: clinical findings/ microscopic findings?

Back 268

1. Sudden complete loss of vision in one eye
2. Pallor of optic disk
3. "Boxcar segmentation" of blood in retinal veins
4. Cherry red macula

Front 269

Cherry red macula- associated disorders?

Back 269

1. Tay-Sach's dz
2. Niemann Pick
3. Central retinal artery occlusion

Front 270

Central retinal art occlusion: rx?

Back 270

1. acetazolamide
2. carbogen- CO2 + O2
3. hyperbaric O2 therapy

Front 271

Central vein occlusion: causes? clinical findings/microscopic findings? rx?

Back 271

1. painless unilateral loss of vision
2. swelling of optic disk
3. engorged retinal veins with hemorrhage- "blood and thunder appearance"
4. rx: laser photocoagulation

Front 272

Glaucoma- types- mechanism

Back 272

open angle- reduced outflow rate through canal of schlemm
angle closure- narrowing of anterior chamber

Front 273

Open angle glauoma- clinical features? rx?

Back 273

B/l aching eyes.
pathologic cupping of optic disk.
night blindness.
tunnel vision

rx:
1st choice: b-blockers-timolol- decreases rate of flow
2nd: Prostaglandins/ alpha agonists/ pilocarpine/ carbonic anhydrase inhibitors.
3rd: laser trabeculoplasty

Front 274

Angle closure glaucoma: clinical features? rx?

Back 274

1. Severe pain
2. Photophobia
3. Blurry vision
4. Pupil fixed and non reactive to light
5. Red eye


rx: pilocarpine +systemic carbonic anhydrase inhibitors(lower pressure): for laser surgery

Front 275

Optic nerve atrophy: causes?

Back 275

1. optic neuritis
2. glaucoma

Front 276

Uveitis: causes? clinical features? rx?

Back 276

causes-
1. sarcoidosis
2. ulcerative colitis
3. ankylosing spondylitis

clinical findings:
1. pain
2. blurry vision
3. circumcorneal vascular congestion
4. normal iop
5. iris and anterior lens capsule adhesions

rx-
corticosteroids
atropine

*uveal tract inflammation- ciliary boides, iris, choroid

Front 277

MCC of permanent vision loss in elderly? pathology?

Back 277

Macular degeneration
Disruption of bruch's membrane in the retina.

Front 278

Macular degeneration: types? rx?

Back 278

dry type: thinning of retina and formation of drusen: yellowish white plaque
wet type: retinal vessels hemorrhage-->retinal cell death --> blind spot/distorted central vision.
rx- antiangiogenic- drug that block vascular growth factors. intraocular lens insertion

Front 279

MCC of blindness in AIDS patients? rx?

Back 279

Cmv retinitis
CD4 count< 50cells/mm^3
Treatment: Oral, IV. Intraocular ganciclovir or foscarnet.

Front 280

Cataracts: causes? rx?

Back 280

1. Age
2. DM
3. Infection- Rubella, CMV
rx: cataract extraction

Front 281

Malignant tumors of the eye? rx

Back 281

Retinoblastoma in children: white eye reflex/cat eye reflex
rx: enucleation

Front 282

Meniere's disease: pathology? clinical findings? rx?

Back 282

1. Increased endolymph in the inner ear +
2. loss of cochlear hairs

Clinical findings:
1. Dizziness
2. vertigo
3. tinnitus
4. sensorineural hearing loss
rx: hydrochlorothiazide + triampterene

Front 283

MCC of sensorineural hearing loss in elderly? rx?

Back 283

Presbycusis
degeneration of hair follicles
rx: amplification devices, cochlear implants

Front 284

MCC of conduction deafness in elderly? rx?

Back 284

Otosclerosis
fusion of middle ear ossicles
other conduction defects: otitis media, impacted cerumen in middle ear.
rx: antipyrine and benzocaine ear drops.

Front 285

External otitis. Etiologic agents? rx?

Back 285

Inflammation of of outer ear canal.
"swimmer's ear"
agents:
1. pseudomonas aeruginosa
2. Staphylococcus aureus
3. Aspergillus
rx: polymyxin b+ neomycin+ hydrocortisone+ selenium sulphide

Front 286

MCC of malignant otitis externa? rx?

Back 286

Pseudomonas aeruginosa
Imipenem- cilastin

Front 287

Spinal nucleus of V: location?

Back 287

Dorsally and laterally - upper pons
(similar to location of dorsal columns in SC)

Front 288

Spinal tract of V: location and extent?

Back 288

Spinal tract of V lies LATERAL to nucleus and
extension from-
-entry point of V nerve
-upto C2

Front 289

Vascular syndromes associated with spinal nucleus and tract?

Back 289

Lateral vascular syndrome: lateral pons and medulla

Front 290

Solitary nucleus: location? CN associated? fn?

Back 290

Location: upper medulla

CN: VII, IX, X

function: receives visceral afferents:
1. Taste, (VII)
2. Cardiorespiratory, (IX, X)
3. GI sensations (X)

Front 291

Nucleus ambiguus:
Location?
CN associations?
function?

Back 291

1. Upper medulla: Dorsal to inferior olive
2. CN IX and X
3. LMN innervation of skeletal muscles of soft palate, larynx, pharynx, upper esophagus
(swallowing and phonation)

Front 292

Dorsal nucleus of X: location? function?

Back 292

Location: upper medulla and lateral to XII nucleus in floor of IV ventricle

Function:
Parasympathetic(PREganglionic) nucleus of brain stem-
Supplies smooth muscles and glands of thorax, foregut and midgut

Front 293

hypoglossal nucleus: location?

Back 293

near midline- beneath central canal and 4th ventricle

Front 294

Accessory nucleus: location? function?

Back 294

location: cervical cord. c2
passes through the foramen magnum ---> cranial cavity ---> exits through jugular foramen.
(intramedullary lesions have no effect on spinal accessory nerve)

fn: supplies trapezius and sternomastoid.

Front 295

IX, X, XII nerve exits from brain stem: location?

Back 295

IX, X: Exit between olive and fibers of inferior cerebellar peduncle
XII: Exit between the olive and medullary pyramid.

Front 296

Abducens nucleus: location? Structure relations?

Back 296

Lower pons: midline floor of 4th ventricle-
#1. Lateral to MLF
#2. Encircled posteriorly by facial nerve fibers( "internal genu" of facial nerve)
#3. Closely associated with PPRF

Front 297

Nuclei in the floor of the 4th ventricle?

Back 297

1. Abducens
2. Hypoglossal
3. Dorsal nucleus of X

Front 298

Superior olivary nucleus: Location? Function?

Back 298

Ventral to VII nuclei--

Fn-
B/l auditory impulses from both cochlear nuclei
Sound localization

Front 299

Vestibular nuclei- Location

Back 299

Posterior surface of pons- lower
Lateral to abducens nucleus
Extends into the medulla

Front 300

Cochlear nuclei-location

Back 300

PM jn lateral to the inferior cerebellar peduncles

Front 301

Trigeminal nuclei- name em?

Back 301

1. Sensory
2. Motor
3. Spinal Trigeminal
4. Mesencephalic

Front 302

Trigeminal nuclei- Motor nucleus: Location? function?

Back 302

Pons: Medial to main sensory nucleus of trigeminal. At exit point of V
Supply muscles of mastication-
1. Medial and lateral pterygoid
2. Temporalis
3. Masseter

Front 303

Trigeminal: Sensory nucleus?

Back 303

Pons: Lateral to motor nucleus. At exit point of V

fn- TACTILE and PRESSURE sense from V1, V2, V3 and DURA

Front 304

Spinal trigeminal nucleus: location? fn?

Back 304

Location: Mid pons to C2
Functions- pain temperature by trigeminal nerve

Front 305

Mesencephalic nucleus : location? function?

Back 305

At point of entry of 5th nerve.
Extends into MIDBRAIN

fn- proprioceptive input from

1. muscles of mastication- sensory limb of jaw jerk
2. extraocular muscles
3. teeth

Front 306

V nerve nuclei associated with point of entry of V nerve?

Back 306

1. Motor
2. Sensory
3. Mesencephalic

Front 307

Sensory distribution of CN V

Back 307

ophthalmic: forhead, scalp, cornea, dorsum of nose
maxillary- maxillary skin
mandible- mandibular skin,
external auditory meatus, external tympanic membrane

"onion skin configuration"- pain and temperature(spinal n.):
1: perioral
2: region of the eye
3: between ears and eyes
4: around the ears

Front 308

Motor fibers of V course through which division of V nerve?

Back 308

Course of tactile fibers from face?
1st neuron: synapses in main sensory nucleus of V
2nd neuron: crosses midline in vicinity of its cell body--> synapses in thalamus(VPM nucleus)
3rd neuron: thalamus up to somatosensory cortex(join with pain fibers)

Front 309

Course of pain fibers from face?

Back 309

1st neuron: enter spinal tract of V--> synapse in spinal nucleus of V
2nd neurons: cross midline in vicinity of CBs--> synapse in thalamus(VPM nucleus)
3rd neurons: thalamus unto somatosensory cortex (join with the tactile fibers)

Front 310

Complete lesion of trigeminal nerve at entry or exit points.

Back 310

Complete ipsilateral anesthesia(sensory and spinal tract fibers)
Jaw weakness(motor fibers)

Front 311

Lateral/caudal pons lesion/lateral medullary lesion?

Back 311

Ipsilateral loss of pain and temperature(spinal tract of V)

Front 312

Corticobulbar/ corticonuclear fibers:

Back 312

CN V- Mastication
CN VII- Facial expression
CN X- Palate, larynx, pharynx
CN XI- Sternomastoid, trapezius
CN XII- Tongue except palatoglossus

Front 313

Difference between cranial and spinal LMNs?

Back 313

1. Cranial- B/L corticobulbar(UMN) innervation--exception lower face from VII(U/L)

2. Spinal- U/L corticospinal(UMN) innervation

Front 314

Hair cells at base of cochlea- sensitive to?

Back 314

High frequency

Front 315

Hair cells at apex of cochlea- sensitive to?

Back 315

Low frequency

Front 316

Weber's test?

Back 316

Tuning fork placed on vertex of skull.**
Conductive- Louder in affected ear
Sensorineural- Louder in normal ear

(**bone conduction interferes with air conduction so decreased perception in
normal ear)

Front 317

Rinne test?

Back 317

For conductive hearing loss
Place tuning fork on mastoid till no vibrations heard and then place next to the
ear.
Unilateral conductive hearing loss- No air conduction after bone conduction

Front 318

Conditions causing conuction deafness?

Back 318

1. Otosclerosis
2. Otits media
3. Impacted cerumen

Front 319

Presbyucusis?

Back 319

loss of hair cells in the base of the cochlea-
progressive loss of high frequency sounds

Front 320

ampular crest
utricle and saccule:fns?

Back 320

ampular crest- angular acceleration
utricle and saccule- linear acceleration(upright posture)

Front 321

Endolymph composition? Site of production?

Back 321

High K+
Low Na+
Striae vascularis

Front 322

superior olive: function?

Back 322

(pons)
sound localization.

Front 323

Lesion above cochlear nucleus?

Back 323

slight hearing loss in both ears
poor localization-olive, lemniscus, thalamus etc

Front 324

lesion below cochlear nucleus?

Back 324

Complete hearing loss in the affected ear

Front 325

Ion channel myopathies?
Microscopy?

Back 325

Myotonia- sustained muscle contraction
Episodic hypotonic paralysis
No muscle atrophy

PAS +ve intracytoplasmic vacuoles

Front 326

Vestibular nuclei:
no?
fn?

Auditory pathway?

Back 326

. upright posture- source of UMN- vestibulospinal tract- a/gravity muscles-linear
acceleration hair cells
2. vestibulo-ocular reflex- fixation of the eye in response to head turning
endolymph flow stimulate hair cells on side of turning--->
stimulation of cochlear nerve(on side of turning)--->
stimulates cochlear nucleus--->
i. activates MLF to III nucleus on same side---> adduction(same side)
ii. activates MLF to VI nucleus on opp side---> abduction(pop side)
eyes move in opp direction

Front 327

Vestibular evoked nystagmus

Back 327

Lesion on one sided--> stimulation of opp side.
therefore
"Slow component"-->
1. Points in direction of lesion
(adduction of opp eye
abduction of same eye)
2. Due to the pathology

"fast component"(corrective phase) -->
1. points to opp side of lesion
2. Due to cortical mediated correction

Front 328

Caloric test?

Back 328

Brain stem fun in unconscious pts.
Cold water irrigation--> nystagmus to opp side
Warm water irrigation--> nystagmus to same side
COWS


cool water= mimics lesion
warm water= mimics stimulation

Front 329

vertigo?

Back 329

perception of rotation
acute vertigo--> peripheral lesion
chronic vertigo--> central lesion

Front 330

For conjugate movement to right
cortical gaze center in the frontal eye field: location?

Back 330

left cortex

Front 331

Fibres for conjugate gaze: Pathway?

Back 331

Descend down to brain stem and cross to the opposite side-->
Paramedian pontine reticular formation-->
1. Abducens on same side as PPRF
2. Oculomotor on opp side of PPRF(through the MLF)

Front 332

Paramedian pontine reitcular formation: location?

Back 332

Pons: adjacent to VI nucleus.

Front 333

MLF: Medial longitudanal fasciculus?

Back 333

Heavily myelinated tracts:
axon fibers to and from III/IV/VI/VIII nerve

Front 334

Right abducens nerve lesion: Effect?

Back 334

When patient asked to look right (from looking left position)
Left eye adduction possible
Right eye abduction possible only upto the center:
Reason:
III nerve intact
Superior oblique: weak abduction
Inferior oblique: weak abduction

Front 335

Right abducens nucleus lesion: Effect?

Back 335

1. Neither eye can look right.
Since abducens nucleus - very close to the PPRF

2. Compete right side facial paralysis(internal genu of facial nerve)


***PPRF, abducens nucleus and internal genu (VII)ALWAYS involved together***

Front 336

Left MLF lesion : fn? Commonly involved disease?

Back 336

Associated with IIIrd nerve function: adduction during conjugate gazing
MS
Failure to adduct eye during gaze
AKA "Internuclear ophthalmoplegia"

Front 337

Differentiate MLF lesion from pure oculomotor lesion?

Back 337

In IIIrd nerve palsy:
1. Complete failure of adduction of the eye
2. No dilation of pupil and
3. Ptosis

MLF lesion-
convergence of eye possible. failure of adduction of eye only in conjugate gazing

Front 338

Left frontal eye field lesion?

Back 338

1. Inability to move either eyes to right.
Facial muscle weakness-LOWER face- proximity of corticobulbar fibres to the frontal eye field.
UPPER half spared.

Front 339

Pateint fails to move both eyes to right:
whats the site of the lesion?
A. Right frontal eye field
B. Left frontal eye field
C. Right PPRF
D. Left PPRF

Back 339

Either Left frontal eye fielder OR right PPRF
Left frontal eye field lesion: Lower 1/2 of face involved only(right-opp side of lesion)
PPRF: entire face involved.(right-same side of the lesion)

Front 340

Brainstem- supplied by(blood supply)?

Back 340

Vertebrobasilar system

Front 341

Basilar artery formed by? location?

Back 341

Joining of the vertebral arteries.
Pontomedullary junction

Front 342

Course of basilar artery?

Back 342

Formed at PM jn--> runs along the medial surface of pons--> bifurcates into
post cerebral arteries at midbrain

Front 343

Medulla: blood supply?

Back 343

Medial medulla-
Anterior spinal artery fed by vertebral artery
Lateral medulla-
PICA

Front 344

Pons- blood supply?

Back 344

Medial: Basilar artery(paramedian branches)
Lateral-caudal(VII and VIII) - AICA.
Lateral-rostral- superior cerebellar artery

Front 345

Cerebellar arteries:
Name em.
Structures supplied?

Back 345

1. Superior- Rostral pons
2. Inferior-
a. Anterior(AICA)- Caudal pons
b. Posterior(PICA)- Lateral medulla

Front 346

Midbrain-blood supply?

Back 346

Posterior cerebral artery- medial and lateral

Front 347

Brain stem lesions- tracts affected with side.

Back 347

Spinothalamic- C/L
Corticospinal-C/L
Medial lemniscus-C/L
Descending hypothalamic fibres- I/L(horner's)
CN involved: I/L signs/symptoms

Front 348

Above brain stem level lesion: Effects?

Back 348

IC/Thalamus/Cortex-
ALL-
C/l signs and symptoms
Lower 1/2 face weakness

Spinothalamic fibers and descending hypothalamic fibers go together.
lesion of one produces another in brain stem.

Front 349

medial lemniscus system- course across the brain stem?

Back 349

medially in medulla
laterally in the mid brain

Front 350

Nuclei lined across-
medially to laterally along floor of 4th ventricle,

Location of nuclei in upper medulla.

Back 350

hypoglossal-dorsal nucleus of X- solitary nucleus-vestibular nucleus
medial lemniscus- medially

nucleus ambiguus- dorsal to the inferior olive

CS tract dorsal to medial lemniscus

CN IX and X- exit between inferior olive and pyramids

CN XII- exits between the inferior olive and inferior cerebellar peduncle

spinothalamic and hypothalamic tracts anterolaterally next to olive

spinal trigeminal tract and nucleus adjacent to inferior cerebellar nucleus

Front 351

Medial medullary syndrome: cause? effect?

Back 351

Cause- Anterior spinal artery occlusion
effect-
pyramids- C/l spastic paralysis
medial lemniscus- C/l loss of tactile, vibration, proprioception
hypoglossal- I/l flaccid paralysis--> tongue deviation on protrusion
towards the side of the lesion

Front 352

Lateral medullary syndromes(Wallenberg syndrome): cause? effect?

Back 352

Cause: PICA

Effect:
1. Spinothalamic tract- C/l loss of pain and temperature
2. Descending hypothalamic fibers: I/L horner's syndrome
3. CN IX, X- Hoarseness, weak vocal cords, dysarthria, dysphagia
4. Spinal nucleus and tract- I/L loss of pain and temperature of face
5. Vestibular nucleus- N/V and vertigo
6. Cerebellar peduncle- I/L ataxia

Front 353

Medial caudal pontine syndrome: Cause? Effect?

Back 353

Cause: Basilar artery(paramedian branches)
Effect:
1. Corticospinal- C/l spastic paralysis
2. Medial lemniscus- C/l loss of pressure/vibration
3. CN VI: strabismus- internal/medial

Front 354

Lateral pontine syndromes: Cause? Effect?

Back 354

AICA
1. Spinothalamic tract: C/l pain and temperature- limbs/trunk
2. Descending hypothalamic fibres- I/L horner
3. Spinal nuclei and tract- I/L pain and temperature- face
4. VII- I/l facial muscle paralysis(LMN)
5. VIII- I/l hearing loss

Front 355

Pontocerebellar angle syndrome: cause? effect?

Back 355

Cause: Acoustic neuroma
Effect:
Affects CN VIII
Compression of V, VII(LMN)

ABSENCE OF LONG TRACT LESIONS

Front 356

Medial midbrain syndrome.

Back 356

Corticospinal tract: C/l spastic lesion
Corticobulbar tract: C/l lower face weakness(UMN)
III nerve lesion: I/L external strabismus, dilated pupils and ptosis

Front 357

Dorsal midbrain sydrome.

Back 357

Pineal gland tumor: directly above superior colliculus and pretectal area
1. Disruption of vertical conjugate gaze
2. Diminished pupillary light reflex(pretectal area compression)
3. Elevated ICP- non communicating

Front 358

Reticular nuclei: name em.(Reticular formation)

Back 358

1. Raphe nuclei
2. Locus ceruleus
3. Periaqueductal gray

Front 359

Raphe nucleus:
Location?
Function?

Back 359

Location- Midline of brain stem- extends from medulla to midbrain
Function- serotonin(dorsal raphe nucleus)

Front 360

Locus ceruleus: function?

Back 360

Synthesize norepeinephrine.
(associated with arousal/ sleep wake cycle)

Front 361

Periacqueductal gray:
location?
function?

Back 361

Collection of nuclei surrounding cerebral aqueduct
Opioid receptors in periaqueductal gray- collaterals to spinothalamic tract-help suppress painful stimuli

Front 362

Cerebellum: parts? function?

Back 362

Midline vermis: axial and proximal
Intermediate hemisphere: distal
lateral hemisphere: motor planning
flocculonodular lobe: balance and smooth conjugate gaze of eye muscles.

Front 363

Vermis/intermediate zone: function? input from?

Back 363

Ongoing motor smooth execution of axial and proximal muscles.
input: proprioceptive inputs from muscle spindles and golgi tendon organs.

Front 364

Input to cerebellum from spinal cord thru ___cerebellar peduncle/s

Back 364

Inferior and Middle
(IIM- Input inferior and middle)

Front 365

Output from cerebellum to spinal cord thru___cerebellar peduncle

Back 365

Superior.

(OS)

Front 366

Lateral hemisphere:input from? function?

Back 366

Input:
1. Cerebrum
2. Inferior olive: error detection
function: motor planning

Front 367

Flocculonodular lobe: input from? function?

Back 367

Input : Vestibular nucleus.(VIII)
function: balance and eye movements

Front 368

Cerebellar cortex layers?

Back 368

Molecular layer:
Outer layer-
cells:
basket cells
stellate cells
parallel fibers(axons of granule cells)


Purkinje cell layer:
Middle- most important cell layer
cells: purkinje cells

Granular cell layer:
innermost layer
cells:
Golgi cells
Granule cells
Glomerulus= Granule cell+ golgi cell axons+ glial capsule
granule cells= the only excitatory cells in cerebellum

Front 369

The only excitatory cells in cerebellum ____

Back 369

Granule cells

Front 370

The only cells whose axons leave the cerebellum____

Back 370

Purkinje cells

Front 371

Purkinje cell: function and location?

Back 371

Cerebellar middle layer- purkinje layer
function-
all inputs to cerebellum influence firing of purkinje cells
Only axons of purkinje cells leave the cerebellum.(longest axons in the CNS)----> influence deep Cerebellar nuclei(cerebellar medulla)

Front 372

All(except granule cells) outputs of cerebellum are: excitatory/inhibitory?

Back 372

Inhibitory

Front 373

All input to cerebellum are: excitatory/inhibitory?

Back 373

Excitatory

Front 374

Inputs to cerebellum:
fibers?
associated tracts?
Target and function?

Back 374

Mossy fibers:
Vestibulocerebellar--->Granule cells(excitatory- glutamate)---> purkinje cells
Spinocerebellar--->Granule cells(excitatory- glutamate)
fn: balance, smooth coordination

Climbing fibers:

Olivocerebellar--->Purkinje cells(excitatory)
(inf. olives)
fn: error detection

Front 375

Spinocerebellar and Vestibulocerebellar circuit system through cerebellar cortex?

Back 375

Mossy fibers---> Granule cells---> Parallel fibers (axons of granule cells)--->Purkinje cells---> CB cells

Front 376

Olivocerebellar circuit system through cerebellar cortex?

Back 376

Climbing fibers---> Purkinje fibers--->CB cells

Front 377

Cerebellum cell types? Target? Transmitter? function?

Back 377

Cerebellum cell types? Target? Transmitter? function?
Purkinje cells-CB nuclei-GABA-Inhibitory
Granule cells-Purkinje cells-glutamate-Excitatory
Stellate cells-Purkinje cells- GABA- Inhibitory
Basket cells- Purkinje cells-GABA-Inhibitory
Golgi cells-Granule cells-GABA-Inhibitory

Front 378

Deep CB nuclei? associated cerebellar parts?

Back 378

Fastigial: Vermis
Interposed: Globose+ Emboliform: Paravermis/intermediate
Dentate: Lateral

Front 379

Basal ganglia: Fn?

Back 379

1. Initiation
2. Suppression of unwaned movements
3. Gross motor

Front 380

Structural organization across horizontal section (CT head)

Back 380

Caudate- striatum
Putamen-striatum
separated by ant limb of internal capsule
An
External, internal globus pallidus(medial to putamen therefore lateral to the IC)

Caudate- ant limb of IC-globus pallidus and putamen

Substantia nigra
subthalamic nucleus

Front 381

Basal ganglia circuit?

Back 381

Cerebral cortex(motor)--> VL thalamus--> direct/indirect basal ganglia

Front 382

DIRECT basal ganglia pathway?
Effect?

Back 382

DIRECT
Cortical excitation(glutamate)
striatum(CAUDATE/ Putamen)(GABA)
Globus pallidus-Internal(GABA)
Thalamus(VA/VL)
Motor cortex-->initiation of movement

Direct: Drives movement

Front 383

INDIRECT basal ganglia pathway?
Effect?

Back 383

Cortical excitation(glutamate)
Striatum(GABA)
Globus pallidus-External(GABA)
Subthalamic nucleus(Glutamate)
Globus pallidus- Internal(GABA)
Thalamus(VA/VL)
Motor cortex-->inhibition of movement

Indirect: Inhibits movement

Front 384

Dopaine: site of formation? receptors? fn?

Back 384

Dopamine-
dopaminergic neurons- substantia nigra
Stimulate
D1- Direct(GABA)
D2-Supress indirect pathway

Dopaminergic drive the direct pathway.
Dopaminergics drive movement.

Front 385

Cholinergic transmission: Role in basal ganglia functioning?

Back 385

Striatum
Stimulate-->indirect--> inhibition

Front 386

Diseases of basal ganglia?

Back 386

Parkinson's: pathology
Direct basal ganglia pathway--loss of dopaminergic neurons-b/l
So motor cortex active--loss of dopaminergic.
therefore decreased direct pathway activity
increased indirect pathway activity

Tremor at rest


Huntington's disease: Part of motor system affected?
Associated with defective indirect pathway
loss of GABA neurons in indirect pathway.
Overactive motor cortex.

Front 387

Hemiballism: Part of motor system affected? symptoms?

Back 387

Subthalamic nucleus- indirect structure
Wild flinging of movements
U/L problem--> C/L effect
associated with hypertension

Front 388

Tourette's dz: part of motor system affected?

Back 388

Indirect basal ganglia phenomenon
Associated with
OCD
ADHD
Rx- antipsychotics

Front 389

Wilson's dz: associated tremors?

Back 389

Wing beating tremor- upper limb tremors associated with intention

Front 390

Intentional tremors: lesion in ___(part of CNS)

Back 390

Cerebellum

Front 391

Eyeball layers? fn?

Back 391

Outer-
Sclera-
Attachment site for ocular movement muscles
Corneal sensory fibers
Autonomic sensory fibers

Middle- Choroid- Blood supply to retina

Inner-Retinal fibers

Front 392

Refractive areas of the eye?

Back 392

Cornea- Non adjustable
Lens- Adjustable

Front 393

Posterior chamber- associated fn?

Back 393

Ciliary bodies: epithelium produce aqueous humor

Front 394

Drainage of aqeous

Back 394

canals of schlemm at angle of anterior chamber

Front 395

Parasympathetic and symathetic nerve supply to the eyes.

Back 395

Parasympathetics-
III innervate ciliary muscle- sphincter- constrictor

sympathetic- dilator -radial muscles

cornea supplied by by V1 of trigeminal

Front 396

Light reflex pathway?

Back 396

Retina-->CN II-->
b/l to midbrain nuclei(adjacent to sup.colliculi) pretectal nuclei-->
b/l Edinger Westphal nuclei III nerve nucleus(parasympathetic-pregang)-->
III nerve--->
Ciliary ganglion(parasympathetic- postgang)-->
pupillary sphincter ms-->miosis

Afferent: CN II (Pretectal)
Efferent: CN III (Edinger westphal and ciliary ganglion)

Front 397

Parasympathetic controlled muscles of the eye? Receptor? fn?

Back 397

Pupillary sphincter
Ciliary muscles

Receptors:
Radial: alpha receptors
Ciliary: beta receptors

Fn:
Radial: mydriasis
Ciliary body epithelium: aqueous humor secretion

Front 398

Accommodation convergence reaction: components?

Back 398

Accommodation
Convergence
Miosis

Front 399

Accommodation convergence: Pathway involved?Parasympathetics-->

Back 399

Parasympathetics-->
Ciliary contraction-->
Suspensory ligament relaxation-->
Increased convexity of lens-->
Increased RI of the lens-->
Near object focus

Front 400

Convergence: Involved muscles?

Back 400

Skeletal muscle axons(III)-->
Medial recti

Front 401

Argyll Robertson pupil?
Associated dzs?
Lesion site?

Back 401

Diminished light reflex
Accommodation reaction preserved

Associated dzs -
1.Tabes dorsalis
2. Diabetes

Front 402

Marcus gunn pupil?
associated dz?
associated test?

Back 402

Diminished pupillary light reflex.

Swinging light test:
normal eye-- pupils constrict normally
swing light immediately in affected eye--> dilation of both pupils
associated dz: MS

Front 403

Horner's syndrome?

Back 403

Lesion of oculosympathetic fibers:
T1- superior cervical ganglion
syndrome-peripheral
descending- central
ptosis, miosis and hemianhidrosis
Ipsilateral

Front 404

Adie pupil?

Back 404

Poor light reflex
Good accommodation
lesion of ciliary ganglia
suppressed knee jerks/muscle streth reflex

Front 405

Transtentoral herniation: eye effect?

Back 405

Uncal herniation--> compression of IIIrd nerve- "Down and out"
miosis- 1st sign.(since parasympathetic fibers are the outermost hence affected 1st)
ptosis

Front 406

Retina: layers?

Back 406

Ganglion layer
Inner nuclear layer
Outer nuclear layer

Outer segments associated with pigment epithelium

Front 407

Site of detachment of retina?

Back 407

Outer segments are embedded in pigmented epithelium-->ultimately the retina degenerates due to lack of nutrients

Front 408

Pigmented epithelia: fn?

Back 408

pigmented epithelia--> transport glucose and vit a to outer segment of rods and cones

Front 409

Rods- distribution? function?

Back 409

Distributed across the retina except the fovea


Fn-
Motion sensitive
Night vision

Front 410

Optic pathway

Back 410

3 Neuron pathway:
#1. Photoreceptors-->BIPOLAR CELLS(inner nuclear layer)
#2. Ganglion cell layer(optic nerve)--->
lateral geniculate body
Pretectal area(light reflex)
suprachiasmatic nucleus(hypothalamus)
#3.

Front 411

2nd optic neurons cross midline: unique features?

Back 411

1. Only 60% cross midlines @ optic chiasm(nasal nerve optic retina)
Temporal DO NOT.
NASAL NERVES CARRY TEMPORAL information
THEREFORE TEMPORAL HEMIFIELD INFO CROSS.
2. Cross above the level of their cell bodies

Front 412

Optic tract? Projecting nuclei?

Back 412

Remixed optic nerves:
temporal retina+ nasal retina from opp eye

Nuclei:
Geniculate body
Pretectal area

Photoreceptors-->
Bipolar cells-->
Ganglion cells-->
Optic nerves-->
Optic chiasm-->
Optic tracts-->
Lateral geniculate body-->
Optic radiations-->
Prim visual cortex= Cuneal gyrus + Lingual gyrus

Front 413

Lesion ahead of optic chiasm:
Associated conditions?
effect?

Back 413

associated conditions:
1. Optic neuritis(MS)
2. Central retinal artery occlusion
3. Internal carotid artery aneurysm

effect:
Complete monocular ipsilateral anopsia

Front 414

Lesion at optic chasm?
associated with?
effect?

Back 414

1. May affect only temporal fibers
associated lesion-
Medially expanding aneurysm of internal carotid artery.


effect-
IPSILATERAL
MONOCULAR
NASAL hemianopsia

OR

2. AT chiasm
Affect only nasal fibers


Effect-
BINOCULAR
BITEMPORAL(heteronymous)

Associated lesions-
1. adenoma- superior quadrantanopsia
2. craniopharyngioma- inferior quadrantanopsia

Front 415

Adenoma: associated visual field changes?

Back 415

1. Bitemporal
2. Superior quadrant
3. Quadrantanopsia
(aDenoma comes from Down)

Front 416

Craniopharyngioma: associated visual field changes?

Back 416

1. Bitemporal
2. Inferior
3. Quadrantanopsia
(Craniopharyngioma comes from the Ceiling)

Front 417

Lesions Past the chiasm:
Standard features-
monocular/binocular?
homonymous/heteronymous?

Back 417

features:
BINOCULAR
HOMONYOUS

Front 418

MCA occlusion: visual structures affected?

Back 418

Optic tracts
Optic radiations

Front 419

PCA occlusion: visual structures affected?

Back 419

Primary visual cortex

Front 420

Optic tract lesions: features?

Back 420

C/L Homonymous hemianopsia

Front 421

Lateral geniculate body lesion: features?

Back 421

C/L Homonymous hemianopsia

Front 422

Optic radiations' lesions: features?

Back 422

#1. Meyer's loops: C/L homonymous sup quad hemianopsia
#2. Non Meyer's loops: C/L homonymous inf quad hemianopsia

Front 423

Meyer's loop?
associated lesions?
Associated cerebral lobe?
Target?

Back 423

Meyer's loops fibers - lower retinal fibers traversing laterally
(as meyer's loop)- carry superior visual info

Associated lobe:
Temporal lobe

Associated lesion:
1. MCA infarct
2. Temporal lobe tumor

Target:
Lingual gyrus

Front 424

Lingual gyrus:
Location?
Function?

Back 424

Location: Occipital lobe: prim visual cortex
Function: SUPERIOR VISUAL FIELD info processing

Front 425

Cuneus gyrus:
Location?
Function?

Back 425

Location: Occipital lobe: prim visual cortex
Function: INFERIOR VISUAL FIELD info processing

Front 426

Non meyer's loop lesion:
effect?
target?

Back 426

effect: C/L Homonymous inf quadrantanopsia
target: Cuneus gyrus

Front 427

Complete lesions of optic tract and optic radiations have the same effect: ?
differentiating factor?

Back 427

C/L homonymous hemianopsia:

Optic tract lesion will have slightly diminished pupillary light reflex
Optic radiation lesion: no effect on pupillary light reflex.

Front 428

Primary visual cortex:
effect?
cause?

Back 428

effect:
C/L Homonymous hemianopsia
Macular sparing

Front 429

Macular sparing in primary visual cortex lesion: cause?

Back 429

Cause of prim visual cortex lesion: PCA infarct
Macular vision area in cortex is supplied by collaterals from MCA
(in addition to PCA)

cause:
PCA infarct

Front 430

Diencephalon: components?

Back 430

Thalamus
Hypothalamus
Epithalamus: pineal gland
Subthalamus

Front 431

Mammillary bodies: fn?

Back 431

Associated with memory consolidation
sites of degeneration from korsakoff psychosis

Front 432

Thalamic nuclei: Name em.

Back 432

VPL
VPM
VA
VL
MGB
LGB
Ant
MD

Front 433

VPL: Input? Output?

Back 433

Input: Sensory from body and limbs(Limbs=vpL)
Spinothalamic and Medial lemniscus
Output: Somatosensory cortex
vPm or vPl= Pain(sensory)

Front 434

VPM: Input? Output?

Back 434

Input: Sensory relay from face(Makeup=vpM) and taste

Output: Somatosensory cortex
vPm or vPl= Pain(sensory)

Front 435

VA: Input? Output?

Back 435

Input: Motor info from BG(Globus pallidus, substantia nigra)
Output: Primary motor cortex

Front 436

VL: Input? Output

Back 436

Input: Motor info from BG(GP), cerebellum(Dentate nucleus)
Output: Primary motor cortex: brodmann area 4

Front 437

LGB:Input? Output?

Back 437

Input: Visual info from optic tracts
Output: Visual cortex
(L= Light)

Front 438

MGB: Input? Output?

Back 438

Input: Auditory info from inferior colliculus
Output: Auditory cortex
(M= Music)

Front 439

AN: Input? Output?

Back 439

Input: Mammillary nucleus.(short memory processing into long term): "Mammillothalamic tracts"
Output: Cingulate gyrus(part of PAPEZ circuit)

Front 440

Papez circuit?

Back 440

Mammillar bodies--> Mammillothalamic tract-->Anterior nuclear group thalamus--> Ant limb of internal capsule--> Cingulate gyrus--> Hippocampus-->fornix-->Mammillary bodies

Front 441

MD: fn? stimulation associated with?

Back 441

Input: amygdala, prefrontal cortex and temporal cortex
Output: Prefrontal cortex and cingulate gyrus
Medial-dorsal nucleus.
Involved in memory- damaged in Wernicke- Korsakoff syndrome
Stimulation produces savage behavior

Front 442

Pulvinar: fn?

Back 442

Integrate somatic visual and auditory input

Front 443

Midline/intralaminar:Input? Output? fn?

Back 443

Input:
Reticular formation
Spinothalamic tract

Output:
Cingular gyrus

fn
Associated painful stimulus should be avoided in the future

Front 444

Limbic system: fn?

Back 444

5 Fs:
Feeding
Feeling
Fleeing
Fighting
Fornicating

Front 445

Ventral nuclear group:
lesion associated with isolated lacunar stroke?

Back 445

Thalamic pain syndrome:
1. loss of position and vibration sense
2. Increased C/l pain-burning aching resistant to analgesic medications

Front 446

Hypothalamus:
location?

Back 446

1. Collection of nuclei in the wall of the 3rd ventricle
2. Above the optic chasm
3. Above the pituitary

Front 447

The only grossly visible part of the hypothalamus?

Back 447

1. Mammillary bodies.
2. Posterior lobe of the hypothalamus

Front 448

Gross structures closely associated with location of hypothalamus?

Back 448

1. Optic chiasm
2. Posterior pituitary
3. Mammillary bodies.

Front 449

Preoptic area:
Derived from ___?
function?
Effect of pre-optic lesions?

Back 449

Telencephalon

Fn:
sex hormone RELEASE FACTOR production(estrogen/androgen)

Effect:
Before puberty: arrest of sexual development
After puberty: Impotence and Amenorrhea

Front 450

Anterior region:
Location?
Nuclei?
fn?
effect of lesion?

Back 450

Location-
Directly above the optic chiasm

Nuclei:
1. Paraventricular
2. Supraoptic
3. Suprachiasmatic

Function:
Paraventricular and supraoptic
1. ADH
2. Oxytocin production and release into post pituitary(neurohypophysis)

lesion--> diabetes insipidus
polyuria
polydipsia

Front 451

Suprachiasmatic: fn?

Back 451

1. Circadian rhythm---> influences pineal gland
(Visual input from retina)
supraChiasmatic= Circadian)

Front 452

Post pituitary contain____

Back 452

Axons of paraventricular and supraoptic nuclei

Front 453

Anterior pituitary derived from? cell types in pituitary?

Back 453

From Rathke's pouch
Dorsal outgrowth of oral ectoderm.

cell types-
Acidophils
Basophils

Front 454

Arcuate nuclei:
location?
fn?

Back 454

Location:
hypothalamus- directly above the infundibulum

fn: control release of anterior pituitary hormones.
thru releasing and inhibitory factors--->hypophyseal-portal veins-->secondary capillary plexus in ant pituitary

Front 455

Ventromedial nucleus: VM nucleus;
location?
Fn?

Back 455

Location: tuberal region of hypothalamus
fn: Satiety center: lesions--> obesity
(VM= Vomit..you are full so you vomit.)

Front 456

Feeding center: location?

Back 456

Lateral hypothalamus
lesions--> aphagia

Front 457

Posterior region:
nuclei/structures?
respective fns?

Back 457

Mammillary bodies- part of limbic system: memory consolidation

Anterior hypothalamic zone:
Senses body-temp elevation-->mediates heat dissipation response
lesion-->hyperthermia

Posterior hypothalamic zone
Senses body-temp drop-->mediates heat conserving response.
lesion-->poikilothermy

Front 458

Hyperthermia: associated hypothalamic lesion?

Back 458

Posterior hypothalamic zone

Front 459

Diencephalic structures associated with thiamin deficiency?

Back 459

1. DM nucleus of thalamus
2. Mammillary bodies

Front 460

Epithalamus? location? fn?

Back 460

Pineal gland : melatonin release(increased during darkness-->sleep)-
plays a role in -
growth/development
circadian rhythm
habenular nucleus(fn:?)

location: above posterior commissure

Front 461

pinealocytes: fn?

Back 461

synthesis :
melatonin
serotonin
cholecystokinin

melatonin production control

through light across the retinal-suprachiasmatic-pineal pathway
light inhibits-->melatonin
darkness stimulate-->melatonin

Front 462

Pineal tumor-effect?

Back 462

Parinuad syndrome:
Compression of
superior colliculus- vertical conjugate gaze impaired
midbrain- pupillary light reflex(pretectal area)

Front 463

Subthalamus: fn? lesion effect?

Back 463

Movement inhibition(indirect basal ganglia pathway)
lesion: hemiballismus--- C/l flinging movements of extremities

Front 464

Primary motor cortex: location? Area no __?

Back 464

Precentral gyrus
Area 4

Front 465

Primary somatosensory cortex: location?

Back 465

Postcentral gyrus
(poStCentral: SomatoSensory)

Front 466

Homunulus orientation across the cortical surface?

Back 466

Laterally head (near lateral sulcus) --->medially legs/feet

Front 467

Primary visual cortex: location? divisions?

Back 467

Location: Medial surface of occipital lobe
division: (by calcarine sulcus)
1. Cuneus gyrus: Superiorly situated: Non meyer's loop info: Inferior visual field info
2. Lingual gyrus: Inferiorly situated- meyer's loops: Superior visual field info

Front 468

Area of brain associated with watershed infarct?
Cause?
Effect?

Back 468

Area: Jn of ACA and MCA
Cause: Hypotension
Effect:
1. Weakness of trunk musculature.
2. B/L loss of pain and temperature in trunk
"Person in a barrel syndrome"

Front 469

Cortical cell layers?

Back 469

1. Molecular layer
2. External granular layer(well developed in sensory cortices)
3. External pyramidal layer(well developed in motor cortices)
4. Internal granular layer(well developed in sensory cortices)
5. Internal pyramidal layer(well developed in motor cortices)
6. Multiform layer

Layer 2, 4 well developed in sensory cortices:
site of synapsis of thalamic relay nuclei

Layer 3, 5 well developed in motor cortices
UMN cell bodies--->from corticospinal/bulbar= aka Betz cells

Front 470

Structures supplied by posterior circulation--->

Back 470

1. Brain stem
2. Cerebellum
3. Medial cerebral hemisphere
4. Inferior cerebral hemisphere

Front 471

MCA- cortical structures supplied?

Back 471

Lateral aspect- upper half of body and face

Front 472

ACA- cortical structures supplied

Back 472

Medial aspect- lower half of body

Front 473

Internal carotid aneurysms
Site?
Effects?

Back 473

Site:
Before it branches off into MCA and PCA

Effects:
1. Medially expanding:
Compress temporal fibers of Optic nerve- Nasal hemianopsia

2. Laterally expanding:
Cavernous sinus
Compression of Abducens nerve- Internal strabismus

Front 474

Margins of cortex supplied by?

Back 474

either-
ACA
PCA

NOT MCA

Front 475

Dominant hemisphere- left/right? blood supply?

Back 475

Left hemisphere-
since it contains the language centers:
Broca's area
Wernicke's area
(both on lateral surface)

Blood supply-
Left MCA

Front 476

Corpus callosum : blood supply?

Back 476

MCA except Splenium- PCA

Front 477

Cerebral artery most commonly associated with emboli?

Back 477

MCA

Front 478

Lacunar infarcts: cause? site? effect?

Back 478

hypertension
penetrating branches of ACA/MCA-
basal ganglia/diencephalon/IC

Front 479

Berry aneurysm: associated dzs?

Back 479

1. Marfan's dz
2. ED type IV
3. ADPKD
4. Htn
5. Smoking

Front 480

Brodman areas?

Back 480

Primary motor area: 4
Primary somatosensory area: 3,1,2
Primary visual cortex: 17
Oral comprehension: 22 (Wernicke's)
Written comprehension: 39 (Angular)
Auditory complex: 41 and 42
Visual field/voluntary c/l horizontal gaze: 8
Motor speech area: 44, 45

Front 481

Premotor areas: fn? brodman no? input from? lesion effect?

Back 481

Motor planning
area 6

input: basal ganglia, cerebellum

lesion effect:
Apraxia
No weakness

Front 482

Somatosensory association area: location? fn? lesion effect?

Back 482

Location:
Parietal lobe: lateral aspect
Posterior to area 3,1,2.
fn: Integration of sensory systems

Lesion effect:
Astereognosia
No loss of touch /pressure sense

Front 483

Astereognosia and apraxia more common in _____(lt/rt) hemisphere damage?

Back 483

Lt hemisphere damage

Front 484

Frontal eye field: location: brodman no?

Back 484

Frontal lobe: lateral aspect
Anterior to area 6
Brodman no :Area 8

Front 485

Primary auditory complex: location? B no? lesion effect?

Back 485

location: Superior bank of temporal lobe under lateral sulcus
B no: 41 and 42
Lesion effect:
1. B/L slight diminution of sound
2. Poor sound localization

Front 486

Visual cortex: location? brodman no?

Back 486

Location: Medial aspect of occipital lobe
Brodman no: 17

Front 487

Language centers? location? blood supply?

Back 487

Broca's:
44 and 45 (motor speech areas)
Location:
Lateral aspect of frontal lobe
Anterior to premotor cortex

Wernicke's:
22(oral comprehension)
loaction
left temporal lobe- lateral
Posterior to prim auditory complex

Angular gyrus:
39(written comprehension)
location:
lateral aspect of parietal lobe-adjacent to visual association cortex

Front 488

Aphasia: name em
Common features?

Back 488

1. Broca's
2. Wernicke's
3. Gerstmann's
4. Conduction


Agraphia

Front 489

Broca's aphasia: site? symptoms?

Back 489

Reduced use of words- use of monosyllable words
aware and frustrated
lesion may extend into adjacent primary motor areas:
c/l spastic limb weakness

Front 490

Wernicke's aphasia site?symptoms?

Back 490

fluent aphasia.
no comprehension
verbal output- n
misuse words- "ford salad"
paraphasic speech
unaware and not concerned by deficit
area 22

Front 491

Gerstmann's syndrome: site? symptoms?

Back 491

Lesion in area 39: angular gyrus

Symptoms
1. Agraphia- cannot write
2. Alexia- cannot understand written material
3. Acalculia
4. Finger agnosia
5. Right-left disorientation
6. Unaware of defect



Spoken language understood

Front 492

Conduction aphasia: site? defect?

Back 492

Defect in fiber bundles that connect language centers
"Arcuate fasciculus"

1. Paraphrasing
2. Word finding pauses
3. Cannot repeat words/execute command-disconnect
4. Pt aware of deficit-- Frustrated

Front 493

Arcuate fasciculus? fn?

Back 493

Fibers connecting language centers in frontal/temporal/parietal lobes
Comprehension-response.

Front 494

Non dominant lesion (Right parietal lobe lesion)dominant lobe?
test?

Back 494

Lesion: U/L neglect on C/L half of the body: left sided
No visual defect but fail to recognize
No somatosensory defect

Test: bisect line or write numbers on a clock face--cram now in right side

Front 495

Visual agnosia: lobe involved?

Back 495

Temporal lobe- inability to recognize visual patterns

Front 496

Prosopagnosia? lesion location?

Back 496

Inability to recognize faces
lesion sites:
1. Area 20 and 21 of temporal lobe
2. adjacent occipital lobe
typically temporal lobe infarct

typical symptom: when person speaks, pt recognizes the individual.

Front 497

Disconnect syndrome: site? fn?

Back 497

Transcortical apraxia
Alexia without agraphia

Front 498

Transcortical apraxia? lesion site?

Back 498

Motor deficit of left arm on verbal command

Vascular occlusion of corpus callossum branches of ACA.
(4/5ths of corpus callosum)

verbal interpretation intact

but information transmission across the corpus callossum from dominant hemisphere to right hemisphere fails to travel.

No motor weakness.

Right arm movement executed successfully on command. (no disconnect problem between wernicke's area and prim motor
cortex on left.

Front 499

Alexia without agraphia. Cause? lesion site?

Back 499

Cause: Occlusion of the left PCA
Left PCA supplies:
1. L.Visual cortex: right
Lesion site:
Splenium of corpus callosum
Can write but cannot comprehend written material.

Front 500

Internal capsule blood supply?
associated tracts?

Back 500

Anterior limb-
medial striate branches
thalmocortical
rostral part of frontal lobes.

Genu-
lenticulostriate branches of MCA
corticobulbar fibers

Posterior limb:
Lenticulostriate branches of MCA
Corticospinal(entire homunculus)
Somatosensory: Thalamocortical projections
effect: C/L spastic paralysis
C/L anesthesia

Front 501

Thalamic nuclei associated with thalamocortical projections?

Back 501

VPL
VPM

Front 502

Structures supplied by Anterior spinal artery? deficit stroke?

Back 502

Ant 2/3rd of spinal cord:
All affected except dorsal columns
compare with ALS(limited to motor problems)

Front 503

PICA: structure supplied? Deficit after stroke?

Back 503

Dorsolateral medulla - wallenberg syndromes

Front 504

Vertebrobasilar system:?

Back 504

Pontine arteries
AICA
Superior cerebellar
Labyrinthine

Front 505

Basilar artery: structures supplied? Lesion effect?

Back 505

Medial aspect of pons
Medial pontine syndrome(CST+ CN VI)

Front 506

AICA: Structures supplied? Lesion effect?

Back 506

Inferior cerebellum cerbellar nuclei
Lateral pontine syndrome:(STT, DHF, CN VII, CN VIII)

Front 507

Structures supplied by Anterior spinal artery? deficit stroke?

Back 507

Ant 2/3rd of spinal cord:
All affected except dorsal columns
compare with ALS(limited to motor problems)

Front 508

PICA: structure supplied? Deficit after stroke?

Back 508

Dorsolateral medulla - wallenberg syndromes

Front 509

Vertebrobasilar system:?

Back 509

Pontine arteries
AICA
Superior cerebellar
Labyrinthine

Front 510

Basilar artery: structures supplied? Lesion effect?

Back 510

Medial aspect of pons
Medial pontine syndrome(CST+ CN VI)

Front 511

AICA: Structures supplied? Lesion effect?

Back 511

Inferior cerebellum cerbellar nuclei
Lateral pontine syndrome:(STT, DHF, CN VII, CN VIII)

Front 512

Superior cerebellar art: structures supplied? lesion effect?

Back 512

Cerebellum and sup peduncle
Rostral and lateral pons= (STT DHF, V)

Front 513

Labyrinthine artery:structures supplied? lesion effect?

Back 513

Inner ear
Sensorineural hearing loss

Front 514

PCA:structures supplied? lesion effect?

Back 514

Midbrain
thalamus
occipital lobe


C/L hemianopsia with macular sparing
Alexia without agraphia.(splenium of corpus callosum)

Front 515

Internal carotid branches? lesion effect of each branch?

Back 515

Ophthalmic artery
Post comm artery
Ant comm artery
Middle Cerebral artery
Posterior cerebral artery

Lesions of respective branches of int carotid.

Ophthal artery- retina- blindness(monocular)

Post communicating artery=
2nd most common aneurysm

Ant cerebral artery=
C/l spastic paralysis of LL

Ant communicating artery:
MC site for developing aneurysm-
B/l temporal inf homonyous quadrant anopsia.

Middle cerebral artery:
upper half of motor homunculus.
1. C/l anesthesia;
2. Gaze palsy= Unable to gaze away from lesion site
3. Aphasia(l)
4. Dysprosodias®
5. Gerstmann synd(L)
6. Hemineglect®

Front 516

Frontal lobe: functions?

Back 516

1. Primary motor cortex/premotor cortex: C/l spastic paresis
2. Frontal eye fields: Eyes deviate to ipsilateral side
3. Broca speech: Expressive, non fluent aphasia(l), motor dysprosodia(monotone- no emotions attached) (r)
4. Prefrontal cortex:

Front 517

Prefrontal cortex: lesion?

Back 517

1. Poor judgement
2. Difficulty concentrating
3. Apathy
4. Inappropriate behavior

Front 518

Parietal lobe: fns? lesions

Back 518

1. Primary somatosensory cortex: C/l hemihypesthesia
2. Superior parietal lobule: C/l astereognosis/apraxia
3. Inferior parietal lobule- area 39(gerstmann syndrome: alexia/dyscalculia/dysgraphia/finger agnosia/CL hemianopia
unilateral neglect(r)

Front 519

Temporal lobe: fns/lesions?

Back 519

1. Primray auditory cortex: B/L diminished hearing
2. Wernicke's: Fleutn aphasia(l), sensory dysprosodia®: emotional content of speech not understood
3. Hippocampus: B/l lesions--> consolidation of short term--> long term memory
4. Amygdala: Kluver Bucy syndrome
5. Olfactory bulb, tract: Anopsia
6. Meyer loop: "Pie in the sky"

Front 520

Occipital lobe : fns/lesions?

Back 520

Visual: C/l hemianopsia with macular sparing

Front 521

Limbic system: fn?

Back 521

Memory consolidation
Emotional response center
Visceral fns- mainly smell
Sex drive
Behavior

Front 522

Unique feature: Olfactory system

Back 522

I. Reaches-
1. temporal lobe
2. amygdala
without thalamic relay

II: Primary olfactory neurons are replaced continuously: 30-120 days.

III. Do NOT form any sensory ganglia

Front 523

Fx of cribriform plate associated with? (lesions)?

Back 523

1. Anosmia
2. CSF rhinorrhea

Front 524

Fns:
Hippocampus
Amygdala
fornix?

Back 524

hipp: memory consolidation

amyg: emotional content to memory

Fornix: Connects hippocampus to the mammillary bodies
loops over diencephalon

Front 525

Kluver bucy syndrome: cause?

Back 525

1. hypotension
2. b/l lesion in amygdala and hippocampus
3. placidity
4. Visual agnosia
5. Hyper metamorphosis
6. Increased oral exploration
7. Hyper/hyposexual
8. Anterograde amnesia