Cranium And Ventricles

Front 1

Foramen at the base of skull

Back 1

Foramen magnum

Front 2

Point where spinal cord meets medulla

Back 2

Cervicomedullary junction

Front 3

Cavity that holds the frontal lobe

Back 3

Anterior fossa

Front 4

Cavity that holds the cerebellum and brainstem

Back 4

Posterior fossa

Front 5

Meningial layers from outside to inside

Back 5

Dura
Arachnoid
Pia

Front 6

Blood supply to dura

Back 6

Middle meningeal artery

Front 7

Major arteries of the brain travel within this space

Back 7

Subarachnoid space

Front 8

Name all the ventricles

Back 8

Lateral
Third
Fourth

Front 9

Parts of the lateral ventricle

Back 9

Frontal (anterior) horn
Body
Atrium trigone)
Occipital (posterior) horn
Temporal (inferior) horn

Front 10

What types of cells make up the blood-brain barrier?

Back 10

Endothelial cells

Front 11

Difference between vasogenic edema and cytotoxic edema

Back 11

Vasogenic occurs outside the cell, cytotoxic occurs within the cells

Front 12

Describe migraine headaches

Back 12

- 75% of patients have a positive family history
- Often preceded by aura involving visual blurring, shimmering, scintillating distortions, fortification scotoma
- Usually unilateral
- Pain is throbbing, exacerbated by light, sound, or sudden head movement
- Nausea and vomiting may occur
- Duration= 30 min to 24 hours

Front 13

Describe complicated migraine

Back 13

May include sensory phenomena, motor deficits, visual loss, brainstem findings

Front 14

Describe cluster headaches

Back 14

- 1/10 as common as migraine
- 5 times more common in men
- Clusters of headaches occur once to several times per day every day over a few weeks then disappear
- Steady boring sensation behind one eye, lasting 30-90 mins
- May include unilateral autonomic symptoms, sweating, nasal congestion.
- Treatment similar to migraine, or oxygen therapy

Front 15

Describe tension headaches

Back 15

- Possibly related to excessive contraction of scalp and neck muscles
- Most common form of headache

Front 16

Headaches symptoms that may be signs of more severe conditions

Back 16

- Sudden "explosive" onset (r/o subarachnoid hemorrhage)
- Headache worse when standing up compared to laying down (r/o low CSF pressure)
- Headache worse laying down (R/o neoplasms)
- Fever, sensitivity to light (r/o infectious meningitis)

Front 17

Vascultis affecting the temporal artieries and other vessels, notably those that supply the eye.

Back 17

Temporal arteritis

Front 18

Define herniation

Back 18

When a mass lesion displaces structures from one compartment into another.

Front 19

Define mass effect

Back 19

Any distortion of normal brain geometry due to a mass lesion

Front 20

The pineal calcification is good for what?

Back 20

As a landmark for measuring extent of midline shift at the level of the upper brainstem.

Front 21

Seven signs of increased intracranial pressure

Back 21

1. Headache (often worse in the morning)
2. Altered mental status (irritability, depressed level of alertness and attention)
3. Nausea and vomiting
4. Papilledema (engorgement and elevation of optic disc)
5. Visual loss
6. Diplopia (double vision)
7. Cushing's triad (hypertension, bradycardia, irregular respirations)

Front 22

What is transtentorial hernination (aka tentorial herniation)?

Back 22

Herniation of medial temporal lobes (particularly uncus)

Front 23

Clinical triad of uncal herniation

Back 23

Blown pupil
Hemiplegia
Coma

Front 24

What is central herniation?

Back 24

Downward displacement of the brainstem

Front 25

Risk factors for aneurysmal rupture

Back 25

Hypertension, cigarette smoking, alcohol consumption

Front 26

Rate of mortality in subarachnoid hemorrhage

Back 26

50%

Front 27

Risk of rebleed after subarachnoid hemorrhage

Back 27

4% 1st day, 20% first two weeks

Front 28

Imaging preferred to detect subarachnoid hemorrhage

Back 28

CT initially, though it may no longer be visible after 2 days

Front 29

Most common locations for hypertensive hemorrhages

Back 29

Basal ganglia, thalamus, cerebellum, pons

Front 30

What is an arteriovenous malformation (AVM)?

Back 30

Congenital abnormalities in which there are abnormal connections between arteries and veins

Front 31

What is a cavernous malformation?

Back 31

Abnormally dilated vascular cavities lined by only one layer of vascular endothelium

Front 32

Three ways in which hydrocephalus can occur.

Back 32

1) Excess CSF production
2) Obstruction of flow at any point in the ventricles or subarachnoid space
3) Decrease in reabsorption via the arachnoid granulations

Front 33

Define communicating hydrocephalus

Back 33

Impaired CSF reabsorption in the arachnoid granulations, obstruction of flow in the subarachnoid space or (rarely) by excess CSF production

Front 34

Define noncommunicating hydrocephalus

Back 34

Obstruction of flow within the ventricular system

Front 35

Describe a magnetic gait

Back 35

Feet barely leaving the floor

Front 36

Signs of hydrocephalus

Back 36

Incontinence
Magnetic gait
Eye movement abnormalities
Signs similar to ICP

Front 37

Describe eye movement abnormalities associated with hydrocephalus

Back 37

1. 6th nerve palsy (slow or developing cases)
2. Inward deviation of one or both eyes (more severe cases
3. Limited vertical gaze

Front 38

What are some treatments for hydrocephalus?

Back 38

1. Ventriculostomy- draining CSF into bag
2. Ventriculoperitoneal shunt

Front 39

What are the symptoms of normal pressure hydrocephalus?

Back 39

1. Gait difficulties
2. Urinary incontinence
3. Mental decline

Front 40

What is normal pressure hydrocephalus?

Back 40

CSF pressure usually not elevated. Characterized by chronically dilated ventricles.Thought to be a form of communicating hydrocephalus with impaired reabsorption at the arachnoid villi.

Front 41

Two broad types of brain tumors.

Back 41

1. Primary CNS
2. Metastatic tumors

Front 42

The most common form of brain tumor in adults.

Back 42

Glioblastoma multiforme

Front 43

70% of tumors are supratentorial, 30% are infratentorial in which (adults or children)?

Back 43

Adults. Opposite is true in children.

Front 44

Most common brain tumor in children.

Back 44

Astrocytoma

Front 45

Signs of brain tumors.

Back 45

Depends on location, but often include headache, signs of increased ICP, and seizures.

Front 46

Prognosis for glioblastoma.

Back 46

Death within a year.

Front 47

Infection of the CSF in the subarachnoid space

Back 47

Infectious meningitis

Front 48

Common features of meningeal irritation.

Back 48

Headache, lethargy, sensitivity to light and noise, fever, neck rigidity (nuchal rigidity) and pain

Front 49

How does a brain abscess present?

Back 49

Expanding intracranial mass lesion,often faster-spreading than tumor. Common features include: headaches, lethargy, fever, nuchal rigidity, nausea, vomiting, seizures, focal signs determined by location of abscess. Fever absent in 40% of cases.

Front 50

What can occur with untreated meningovascular syphilis?

Back 50

Arteritis causing diffuse white matter infarcts, general paresis, dementia, behavioral changes, delusions of grandeur, psychosis, diffuse UMN weakness

Front 51

What neurologic changes can occur with Lyme disease?

Back 51

Meningeal signs and emotional changes, impaired memory and concentration.

Front 52

The most common cause of viral encephalitis.

Back 52

Herpes simplex virus type 1

Front 53

Signs of herpes simplex encephalitis

Back 53

Bizarre psychotic behavior, confusion, lethargy, headache, fever, meningeal signs, seizures. May also include focal signs. Virus causes necrosis of unilateral or bilateral temporal and frontal structures. Can progress to coma and death within days if not treated.

Front 54

What does postinfectious encephalitis look like?

Back 54

Diffuse autoimmune demyelination of the CNS

Front 55

The most common HIV-related neuromanifestation

Back 55

AIDS dementia complex

Front 56

What is the relationship between HIV and encephalopathies?

Back 56

HIV can increase susceptability to numerous infectious disorders of the CNS, including viral, bacterial, fungal, and parasitic infections.

Front 57

Pure motor paresis. Possible areas of involvement?

Back 57

Corticospinal and corticobulbar tract below the cortex and above medulla (internal capsule, basis pontis, cerebral peduncle)

Front 58

Hemiparesis with associated cortical deficits (i.e. aphasia, visual, somatosensory, etc). What structures?

Back 58

Motor cortex, corticospinal or corticobulbar tract above the medulla

Front 59

Unilateral arm and leg paresis or paralysis, sparing the face. What structures?

Back 59

Arm and leg area of motor cortex, corticospinal tract from lower medulla to C5

Front 60

Unilateral face and arm paresis or paralysis. What structures?

Back 60

Face and arm area of primary motor cortex

Front 61

Define Bell's palsy

Back 61

Unilateral facial weakness or paralysis due to facial (peripheral) nerve lesion.

Front 62

Describe multiple sclerosis

Back 62

Two or more deficits separated in neuroanatomical space and time. Thought to be an autoimmune disorder that attacks white matter.

Front 63

What is Lou Gehrig's disease?

Back 63

Amyotrophic lateral sclerosis (ALS), gradual degeneration of both UMN and LMN, eventually leading to respiratory failure and death.

Front 64

Lesions in association cortex cause deficits in:

Back 64

Higher-order sensory analysis or motor planning

Front 65

Term to describe adjacent regions on cortex that correspond to adjacent areas on the body surface

Back 65

somatatopic organization

Front 66

Blood supply to spinal cord arises from branches of which two arteries?

Back 66

Vertebral, spinal radicular

Front 67

Describe the pathway of the corticospinal tract

Back 67

Over 50% from primary motor cortex and rest from premotor and SMA -> corona radiata (cerebral white matter) -> posterior limb of internal capsule -> cerebral peduncles -> ventral pons -> medullary pyramids -> cervicomedullary junction (decussation) -> spinal cord

Front 68

Lateral vs medial motor tracts: Functions

Back 68

Lateral pathways control both proximal and distal muscles and are responsible for most voluntary movements of arms and legs. They include the
lateral corticospinal tract
rubrospinal tract
Medial pathways control axial muscles and are responsible for posture, balance, and coarse control of axial and proximal muscles. They include the
vestibulospinal tracts (both lateral and medial)
reticulospinal tracts (both pontine and medullary)
tectospinal tract
anterior corticospinal tract

Front 69

Rubrospinal tract originates in the:

Back 69

Red nucleus

Front 70

Rubrospinal tract functions?

Back 70

Alternative by which voluntary motor commands can be sent to the spinal cord. Although it is a major pathway in many animals, it is relatively minor in humans. Thought to play a role in movement velocity, as rubrospinal lesions cause a temporary slowness in movement. In addition, because the red nucleus receives most of its input from the cerebellum, the rubrospinal tract probably plays a role in transmitting learned motor commands from the cerebellum to the musculature. The red nucleus also receives some input from the motor cortex, and it is therefore probably an important pathway for the recovery of some voluntary motor function after damage to the corticospinal tract.

Front 71

Vestibulospinal tract functions?

Back 71

Mediate postural adjustments, head movements, balance. It is also important for the coordination of head and eye movements.

Front 72

Reticulospinal tract functions?

Back 72

The reticulospinal tracts are a major alternative to the corticospinal tract, by which cortical neurons can control motor function by their inputs onto reticular neurons. These tracts regulate the sensitivity of flexor responses to ensure that only noxious stimuli elicit the responses. Damage to the reticulospinal tract can thus cause harmless stimuli, such as gentle touches, to elicit a flexor reflex. The reticular formation also contains circuitry for many complex actions, such as orienting, stretching, and maintaining a complex posture. Commands that initiate locomotor circuits in the spinal cord are also thought to be transmitted through the medullary reticulospinal tract. Thus, the reticulospinal tracts are involved in many aspects of motor control, including the integration of sensory input to guide motor output.

Front 73

The two main sensory pathways

Back 73

1) Posterior column-medial lemniscus tract
2) Anterolateral tract

Front 74

Function of the posterior column-medial lemniscal pathway

Back 74

Conveys proprioception, vibration sense and fine, discriminative touch

Front 75

Function of the anterolateral pathway

Back 75

Pain, temperature sense, crude touch