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144 Cards in this Set

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CSF cycle
choroid plexus in ventricles; enters subarachnoid space; removed by arachnoid granulations
CSF composition
less protein and glucose than serum; scant number of cells; inc chloride
Xanthochromia
yellow colored CSF due to bilirubin pigment; indicates subarachnoid hemorrhage
Papilledema of optic nerve
sign of cerebral edema (intracranial hypertension)
Uncal herniation
intracranial hypertension; medial portion temporal lobe thru tentorium cerebelli
S/S of uncal herniation
midbrain hemorrhage; CN III palsy (pupil down/out); mydriasis
Mydriasis in uncal herniation
compression of parasympathetic system
Cerebellar tonsils herniate into foramen magnum
intracranial hypertension
Hydrocephalus
inc CSF volume with distention of ventricles
Non-communicating
blockage aqueduct Sylvius MCC newborn
Communicating
choroid plexus papilloma; scarring of arachnoid granulations
Adults with hydrocephalus
progressive dementia, wide-based gait, urinary incontinence
Open neural tube defects
folate must be adequate before pregnancy; inc AFP
Spina bifida occulta
dimple overlying skin L5-S 1; vertebral arch not completely closed
Meningocele
vertebral defect with meninges
Meningomyelocele
vertebral defect with meninges and spinal cord
Arnold Chiari syndrome
elongation medulla/cerebellar tonsils through foramen magnum
S/S of Arnold Chiari
hydrocephalus, syringomyelia, meningomyelocele
Dandy Walker syndrome
hypoplasia of cerebellar vermis; hydrocephalus
Syringomyelia
enlarged cervical cord; fluid filled cyst in cervical spinal cord
S/S of Syringomyelia
loss pain/temperature upper extremities (spinothalamic); motor loss in hands (anterior horn cells)
Tuberous sclerosis
AD; mental retardation; hamartomas CNS/kidney; shagreen patches skin
Tuberous sclerosis
angiomyolipomas kidneys; rhabdomyoma of heart
Neurofibromatosis
AD; pigmented neurofibromas; cafe au lait spots
Associations with Neurofibromatosis
pheochromocytoma, brain tumors, acoustic neuromas
Meningitis
nuchal rigidity
CSF findings viral meningitis
inc CSF protein, normal CSF glucose, inc lymphocytes
CSF findings bacterial meningitis
inc CSF protein, dec CSF glucose, inc neutrophils
Encephalitis
inflammation of brain; mental status abnormalities; coma
Coxsackievirus
MCC viral meningitis
HSV-1
hemorrhagic necrosis in temporal lobes
Rabies
skunk and bat common vectors; Negri bodies in neurons; hydrophobia; flaccid paralysis
CMV
intranuclear inclusions; periventricular calcification in congenital infection
Polio virus
destruction of anterior horn cells; flaccid paralysis
Subacute sclerosing panencephalitis
slow virus disease due to rubeola
Progressive multifocal leukoencephalopathy
slow virus disease due to JC virus; common in AIDS
Creutzfeldt-Jakob disease
prions; spongiform encephalopathy
Risk factors for Creutzfeldt-Jakob disease
contact with human brain or contaminated beef (bovine disease)
Meningitis newborn
Streptococcus agalactiae (group B) MCC; E. coli (second)
Listeria monocytogenes
newborn meningitis; gram + rods; pregnant mother should avoid soft cheeses
Neisseria meningitidis
MCC meningitis 1 mth-l8-yrs-old; petechia and DIC characteristic
Streptococcus pneumoniae
MCC meningitis > 18-yrs-old
Mycobacterium tuberculosis
complication primary TB; base of brain meningitis with vasculitis
Neurosyphilis
CSF with positive VDRL
Meningovascular syphilis
vasculitis causing strokes
General paresis
syphilis with dementia and brain atrophy
Tabes dorsalis
posterior root ganglia/posterior column; ataxia; absent DTRs; Argyll-Robertson pupil
Argyll-Robertson pupil
pupils accommodate but doe not react to direct light
Cryptococcus neoformans
MC opportunistic CNS fungal disease; positive India ink
Mucor species
frontal lobe abscess in DKA
Toxoplasma gondii
MCC space occupying lesion in AIDS; avoid cat litter and raw meat in pregnancy
Congenital toxoplasmosis
calcification basal ganglia; blindness; mental retardation
Naegleria and Acanthamoeba
amoeba in fresh water; meningoencephalitis
Taenia solium
pork tapeworm; adult with worms definitive host; adult with larva intermediate host
Cysticercosis
larval form of T. solium; produces blindness and calcified cysts in CNS (seizures)
Coup injuries
contusions at site of injury
Contrecoup injuries
contusion on opposite side; frontal and temporal lobes
Epidural hematoma
temporoparietal skull fracture; tear middle meningeal artery
Subdural hematoma
tear bridging veins; venous blood clot; fluctuating levels consciousness
Hypoxic injury
neurons more susceptible to damage than neuroglial cells
Laminar necrosis
liquefactive necrosis at watershed areas in cortex
Atherosclerotic stroke
pale infarction (liquefactive necrosis) extending to periphery of cerebral cortex
Causes of atherosclerotic stroke
thrombosis of middle cerebral artery or carotid artery
MCA stroke
contralateral weakness/sensory loss; expressive aphasia if left hemisphere stroke
Amaurosis fugax
loss vision described as curtain going down and then up
Cause of Amaurosis fugax
embolus atherosclerotic plaque to branch of retinal artery (Hollenhorst plaque)
Vertebrobasilar stroke
vertigo, ataxia, ipsilateral sensory loss face/contralateral hemiparesis/sensory
Embolic stroke
hemorrhagic infarction extending to periphery cerebral cortex due to embolization
Intracerebral hemorrhage
complication hypertension
Cause of intracerebral hemorrhage
rupture of aneurysm of lenticulostriate vessels
Location of intracerebral hemorrhage
basal ganglia MC site
Subarachnoid hemorrhage:
rupture of congenital berry aneurysm; severe occipital headache
Lacunar stroke
microinfarctions; due to hyaline arteriolosclerosis (hypertension, diabetes)
Pure motor stroke
posterior limb internal capsule
Pure sensory stroke
thalamus
Multiple sclerosis
autoimmune destruction myelin sheath/oligodendrocytes; plaques in white matter
S/S of multiple sclerosis
scanning speech, intention tremor, nystagmus, paresthesias, weakness
Bilateral internuclear ophthalmoplegia
multiple sclerosis; demyelination MLF
CSF with oligoclonal bands
sign of demyelination
Central pontine myelinolysis
rapid intravenous correction of hyponatremia in alcoholic
MCC dementia
Alzheimer's disease
Alzheimer's disease genetic cause
chromosome 21 codes for amyloid precursor protein
Alzheimer's disease pathogenesis
increase of amyloid-beta destroys neurons; occipital lobe spared
Alzheimer's disease effect in CNS
increase density of neurofibrillary tangles and senile plaques
Down syndrome and Alzheimer's
develop Alzheimer's disease at early age; 3 functioning chromosome 21s
Apo E gene allele c4
gene product has high affinity for amyloid-beta
Parkinson's disease
depigmentation substantia nigra neurons; Lewy bodies; dec in dopamine
S/S of Parkinson's
extrapyramidal (muscle rigidity), resting tremor, festinating gait
Causes of Parkinson's Disease
CO poisoning, Wilson's, MPTP (meperidine derivative), drugs
Huntington's disease
AD; atrophy of caudate nucleus; trinucleotide repeat disorder on Chromosome 4(anticipation)
S/S of Huntington's Disease
movement disorder; dementia
Amyotrophic lateral sclerosis (ALS):
degeneration of lower/upper motor neurons; no sensory changes
Werdnig Hoffman disease
childhood type of ALS
Wilson's disease
AR; excess copper; cystic degeneration of putamen/globus pallidus
Vitamin B12 deficiency
posterior column (dec proprioception, vibration); lateral corticospinal tract (UMN)
Alcohol and CNS
Wernicke-Korsakoff syndrome, cerebellar atrophy, central pontine myelinolysis
Wernicke encephalopathy
thiamine deficiency; IV with glucose can prompt acute attack
Wernicke encephalopathy
mamillary body hemorrhage (ring hemorrhages)
S/S of Wernicke encephalopathy
confusion, ataxia, nystagmus, ophthalmoplegia
Korsakoffs psychosis
limbic system; antegrade and retrograde memory deficits
Acute intermittent porphyria (AIP):
AD; deficiency uroporphyrinogen synthase; inc porphobilinogen
S/S of Acute intermittent porphyria (AIP):
drug induced (alcohol, barbiturates); abdominal pain ("bellyful of scars"); dementia
Window sill test in Acute intermittent porphyria (AIP):
urine in AIP colorless; turns port wine color with exposure to light (porphobilin)
Rx for Acute intermittent porphyria (AIP):
heme infusions (inhibits 8-aminolevulinic acid synthetase)
Adult brain tumors
70% supratentorial; frontal lobe MC site
Childhood brain tumors
70% infratentorial; cerebellum MC site
Adult brain tumors (descending order):
GBM, meningioma, acoustic neuroma
GBM
high grade astrocytoma; hemorrhage and necrosis; may cross corpus callosum
Meningioma
female dominant; arise from arachnoid granulations; psammoma bodies; seizures
Acoustic neuroma
schwannoma VIIIth nerve; tinnitus; sensorineural hearing loss; neurofibromatosis
Childhood brain tumors
astrocytoma cerebellum (MC), medulloblastoma
Astrocytoma
MC primary brain tumor; frontal lobe MC site in adult (cerebellum in child)
Medulloblastoma
malignant tumor cerebellum; invades fourth ventricle
Ependymoma
arises in 4th ventricle in children and cauda equina in adults
Oligodendroglioma
frontal lobe tumor with dystrophic calcification
CNS lymphomas
metastasis MCC; primary CNS lymphoma associated with EBV in AIDS
Metastasis to the brain
MC brain malignancy; lung cancer MC site of origin; junction gray and white matter
Schwannoma
benign tumor Schwann cell; MC peripheral nerve tumor; alternating dark and light areas
AIDS dementia
due to HIV; multinucleated microglial cells
CMV retinitis
MCC of blindness in AIDS; Rx- ganciclovir (foscarnet if unsuccessful)
Peripheral neuropathy
myelin destruction (sensory; paresthesias); axon destruction (muscle atrophy)
Peripheral neuropathy
DM MCC; thiamine/pyridoxine deficiency; vinca alkaloids
Guillain-Barre syndrome
MCC autoimmune demyelination of peripheral and spinal nerves
Risk factors for Guillain-Barre syndrome
M. pneumoniae, influenza vaccine, Campylobacterjejuni
S/S of Guillain-Barre syndrome
ascending paralysis; CSF- increased protein, lymphocytes; Rx- plasmapheresis
Charcot-Marie-Tooth
AD; common peroneal nerve palsy; inverted bottle appearance
Idiopathic Bell's palsy
facial muscle paralysis due to inflammation of cranial nerve VII
Lyme disease, which nerve is involved
facial nerve MC cranial nerve involved; bilateral Bell's palsy
Bacterial conjunctivitis
Staphylococcus aureus
Viral conjunctivitis
adenovirus MC; HSV-1 (dendritic ulcers)
Sudden loss of vision
amaurosis fugax, central retinal artery or vein occlusion
Uveitis
inflammation of iris, choroid, ciliary body; blurry vision; ankylosing spondylitis, sarcoidosis
Optic neuritis
multiple sclerosis MCC; methyl alcohol poisoning
Glaucoma
increased intraocular pressure; fluid cannot exit canal of Schlemm; causes optic atrophy
Optic atrophy
blindness; pale disc; glaucoma, optic neuritis
Macular degeneration
MCC permanent visual loss in elderly
Meniere's disease
increased endolymph; tinnitus, vertigo, sensorineural hearing loss
Presbycusis
MCC sensorineural hearing loss in elderly
Otosclerosis
MCC conductive hearing loss in elderly; fusion of ear ossicles
Impacted wax in outer ear canal
conduction hearing loss
Weber test lateralizes to left ear, bone > air conduction (Rinne test):
conduction loss left ear
Weber test lateralizes to left ear, air > bone conduction both ears
sensorineural hearing loss right ear
MCC conduction hearing loss in children;
Otitis media, S. pneumoniae MCC
Malignant external otitis in diabetic
Pseudomonas aeruginosa