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