First Aid Neurology -- Anatomy & Physiology

Front 1

What is derived from neuroectoderm?
(4)

Back 1

- CNS neurons
- ependymal cells (inner lining of ventricles --> make CSF)
- oligodendroglia
- astrocytes

Front 2

What is derived from neural crest?
(2)

Back 2

- Schwann cells
- PNS neurons

Front 3

What is derived from mesoderm?
(2)

Back 3

- microglia
- macrophages

"Microglia, like Macrophages, originate from Mesoderm"

Front 4

General info on Neurons?

Back 4

- comprise nervous system
- permanent cells --> do not divide in adulthood

- large cells with prominant nucleoli
- Nissl substance (RER) in cell body, dendrites, NOT axon

Front 5

General info on Astrocytes?

Back 5

- physical support
- repair
K+ metabolism
- removal of excess NT
- maintenance of blood-brain barrier

- reactive gliosis in response to injury

Front 6

What is the astrocyte marker?

Back 6

GFAP

Front 7

General info on Microglia?

Back 7

- CNS phagocytes

- mesodermal origin
- not readily discernible in Nissl stains
- have small, irregular nuclei and relatively little cytoplasm

- microglia --(tissue damage--> large ameboid phagocytic cells

Front 8

What happens to HIV-infected microglia cells?

Back 8

- they fuse to from multinucleated giant cell in the CNS

Front 9

General info on Oligodendroglia?

Back 9

- each one myelinates multiple CNS axons (up to 30 each)
- in Nissl stains, they appear as small nuclei with dark chromatin and little cytoplasm
- predominant type of glial cell in white matter
-resemble fried egg on H&E

Front 10

What cells are destroyed in Multiple Sclerosis?

Back 10

Oligodendrocytes

Front 11

General info on Schwann cells?

Back 11

- each one myelinates only 1 PNS axon
- also promote axonal regeneration

- derived from neural crest

Front 12

What cells are destroyed in Guillain-Barre syndrome?

Back 12

Schwann cells

Front 13

Acoustic Neuroma?

Back 13

- type of schwannoma
- typically located in internal acoustic meatuc (CN VIII)

Front 14

Free nerve endings types, location, function

Back 14

1. C -- slow, unmyelinated fibers
2. Aδ -- fast, myelinated fibers

skin, epidermis, some viscera

sense pain and temperature

Front 15

Meissner's corpuscles general info, location, function

Back 15

- large, myelinated fibers

glabrous (hairless) skin

sense position, dynamic touch, adapt quickly

Front 16

Pacinian corpuscles general info, location, function

Back 16

- large, myelinated fibers

deep skin, ligaments, joints

sense vibration and pressure

Front 17

Merkel's disks general info, location, function

Back 17

- large, myelinated fibers

hair follicles

position sense, static touch (sharp edges), adapt slowly

Front 18

Endoneurium

Back 18

- invest single nerve fiber

- inflammatory infiltrate in Guillain-Barre

Front 19

Perineurium

Back 19

- Permeability barrier

- surrounds a fascicle of nerve fibers

- must be rejoined in microsurgery for limb reattachment

Front 20

Epineurium

Back 20

- dense connective tissue that surrounds entire nerve (fascicles and blood vessels)

Front 21

NE and anxiety?

Back 21

- NE is INCREASED in anxiety

Front 22

NE and depression?

Back 22

- NE is DECREASED in depression

Front 23

Dopamine and schizophrenia?

Back 23

- dopamine is INCREASED in schizophrenia

Front 24

Dopamine and Parkinson's?

Back 24

- dopamine is DECREASED in Parkinson's (and depression)

Front 25

Dopamine and depression?

Back 25

- dopamine is DECREASED in depression (and Parkinson's)

Front 26

5-HT and anxiety?

Back 26

- 5-HT is DECREASED in anxiety (and depression)

Front 27

5-HT and depression?

Back 27

- 5-HT is DECREASED in depression (and anxiety)

Front 28

ACh and Alzheimer's?

Back 28

- ACh is DECREASED in Alzheimer's (and Huntington's and REM sleep)

Front 29

ACh and Huntington's?

Back 29

- ACh is DECREASED in Huntington's (and Alzheimer's and REM sleeep)

Front 30

ACh and REM sleep?

Back 30

- ACh is DECREASED in REM sleep (and Alzheimer's and Huntington's)

Front 31

GABA and anxiety?

Back 31

- GABA is DECREASED in anxiety (and Huntington's)

Front 32

GABA and Huntington's?

Back 32

- GABA is DECREASED in Huntington's (and anxiety)

Front 33

Where is NE synthesized?

Back 33

Locus ceruleus

Front 34

Where is dopamine synthesized?

Back 34

Ventral tegmentum and SNc

Front 35

Where is 5-HT synthesized?

Back 35

Raphe nucleus

Front 36

Where is ACh synthesized?

Back 36

Basal nucleus of Meynert

Front 37

Where is GABA synthesized?

Back 37

Nucleus accumbens

Front 38

What area of the brain makes NT in response to stress and panic?

Back 38

- Locus ceruleus --> NE

Front 39

What is the reward center, pleasure, addiction, fear center of the brain?

Back 39

Nucleus accumbens and Septal nucleus

Front 40

What NT are INCREASED in anxiety?
(1)

Back 40

- NE

Front 41

What NT are DECREASED in anxiety?
(2)

Back 41

- 5-HT
- GABA

Front 42

What NT are DECREASED in depression?
(3)

Back 42

- NE
- dopamine
- 5-HT

Front 43

What NT are DECREASED in Parkinson's?
(1)

Back 43

- dopamine

Front 44

What NT are DECREASED in Alzheimer's?
(1)

Back 44

- Ach

Front 45

What NT are DECREASED in Huntington's?
(2)

Back 45

- ACh
- GABA

Front 46

What NT are DECREASED in REM sleep?
(1)

Back 46

- ACh

Front 47

What 3 structures form the blood-brain barrier (BBB)?

Back 47

1. Tight junctions between nonfenestrated capillary endothelial cells
2. Basement membrane
3. Astrocyte processes

Front 48

What crosses the BBB slowly by carrier-mediated transport mechanism?
(2)

Back 48

- glucose
- amino acids

Front 49

What crosses the BBB rapidly via diffusion?)

Back 49

- nonpolar/lipid-soluble substances

Front 50

A few specialized brain regions with fenestrated capillaries and no BBB allow what?
(2)

Back 50

1. they allow molecules in the blood to affect brain function (ie. area postrema --> vomiting after chemo; OVLT --> osmotic sensing)

2. they allow neurosecretory products to enter circulation (ie. neurohypophysis --> ADH release)

Front 51

What are the 3 blood barriers?

Back 51

1. blood-brain barrier
2. blood-testis barrier
3. maternal-fetal blood barrier of placenta

Front 52

What does a brain infarction destroy in relation to the blood brain barrier? And what does this lead to?

Back 52

- endothelial cell tight junctions

- leads to vasogenic edema

Front 53

What does the Hypothalamus do?

Back 53

"TAN HATS"

- Thirst and water balance
- Adenohypophysis control
- Neurohypophysis releases hormones from hypothalamus

- Hunger
- Autonomic regulation
- Temperature regulation
- Sexual urges

Front 54

Inputs to the hypothalamus?
(2)

Back 54

- OVLT (senses change in osmolarity)

- area postrema (responds to emetics)

Front 55

What makes ADH?

Back 55

Supraoptic nucleus

Front 56

Where is the supraoptic nucleus found?

Back 56

Hypothalamus

Front 57

What makes oxytocin?

Back 57

Paraventricular nucleus

Front 58

Where is the paraventricular nucleus found?

Back 58

Hypothalamus

Front 59

What does the lateral area of the hypothalamus do?

Back 59

controls hunger

destruction leads to anorexia, failure to thrive (infants)

Front 60

What inhibits the lateral area of the hypothalamus?

Back 60

Leptin --> don't feel hungry

Front 61

What does the ventromedial area of the hypothalamus do?

Back 61

controls satiety

destruction leads to hyperphagia

"If you zap your VENTROMEDIAL nucleus, your grow VENTRALLY and MEDIALLY"

Front 62

What stimulates the ventromedial area of the hypothalamus ?

Back 62

Leptin --> feel full

Front 63

What does the Anterior hypothalamus control? And is it controlled via sympathetics or parasympathetics?

Back 63

- cooling

- pArasympathetic

"Anterior nucleus = Cool off"
(A/C = Anterior Cooling)

Front 64

What does the posterior hypothalamus control? And is it controlled via sympathetics or parasympathetics?

Back 64

- heating

- sympathetic

"posterior nucleus = get fired up"

"If you zap your Posterior hypothalamus, you become a Poikilotherm (cold-blooded, like a snake)"

Front 65

What does the Septal nucleus control?

Back 65

Sexual urgers

Front 66

Where is the septal nucleus located?

Back 66

Hypothalamus

Front 67

What does the suprachiasmatic nucleus control?

Back 67

Circadian rhythm

"You need SLEEP to be CHARISMATIC (chiasmatic)"

Front 68

Where is the suprachiasmatic nucleus located?

Back 68

Hypothalamus

Front 69

What are all the areas of the hypothalamus and what do they do?
(8)

Back 69

1. Supraoptic nucleus -- makes ADH
2. Paraventricular nucleus -- makes oxytocin
3. Lateral area -- hunger
4. Ventomedial area -- satiety
5. Anterior hypo -- cooling
6. Posterior hypo -- heating
7. Septal nucleus -- Sexual urges
8. Suprachiasmatic nucleus -- circadian rhythm

Front 70

Posterior pituitary aka?

Back 70

Neurohypophysis

Front 71

What does the posterior pituitary do?

Back 71

- receives hypothalamic axonal projections from supraoptic (ADH) and paraventricular (oxytocin) nuclei

Front 72

Anterior pituitary aka?

Back 72

Adenohypophysis

Front 73

Oxytocin

Back 73

- made by paraventricular nuclei of hypothalamus

- oxys = quick
- tocos = birth

Front 74

What does the Thalamus do?

Back 74

- major relay for ascending sensory information that ultimately reaches the cortex

Front 75

What does the Lateral geniculate nucleus (LGN) control?

Back 75

- visual, CN II

- projects via optic radiations to occipital cortex

"Lateral for Lookin' "

Front 76

Where is the lateral geniculate nucleus (LGN) located?

Back 76

Thalamus

Front 77

What does the Medial geniculate nucleus (MGN) control?

Back 77

- auditory

receives input from superior olive and inferior colliculus of tectum

goes to auditory cortex of temporal lobe

"Medial for Music"

Front 78

Where is the medial geniculate nucleus (MGN) located?

Back 78

Thalamus

Front 79

What does the ventral posterior nucleus, lateral part (VPL) do?

Back 79

- body sensation (proprioception, pressure, pain, tough, vibration via dorsal columns, spinothalamic tract)

Front 80

Where is the ventral posterior nucleus, lateral part (VPL) located?

Back 80

Thalamus

Front 81

What does the ventral posterior nucleus, medial part (VPM) do?

Back 81

- facial sensation (via CNV) -> goes to primary somatosensory cortex

"You put Makeup on your face, and the sensory info is relayed through the VPM"

Front 82

Where is the ventral posterior nucleus, medial part (VPM) located?

Back 82

Thalamus

Front 83

What does the ventral anterior/lateral (VA/VL) nuclei do?

Back 83

motor

"Motor is anterior to sensation in the thalamus, just like the cortex"

Front 84

Where is the ventral anterior/lateral (VA/VL) nuclei located?

Back 84

Thalamus

Front 85

Blood supply to the thalamus?

Back 85

- posterior communicating artery
- posterior cerebral artery
- ICA (anterior choroidal arteries)

Front 86

What all does the LImbic system include?
(4)

Back 86

- cingulate gyrus
- hippocampus
- fornix
- mammillary bodies

Front 87

What all is the Limbic system responsible for?
(5)

Back 87

"The Famous 5 F's"

- Feeding, Fighting, Fleeing, Feeling, and *******

Front 88

What info does the cerebellum receive?

Back 88

- receives CONTRAlateral cortical input via middle cerebellar peduncle

- receives IPSIlateral proprioceptive info via inferior cerebellar peduncle

Front 89

What are the input nerves to the cerebellum?

Back 89

- climbing and mossy fibers

Front 90

What does the cerebellum do?

Back 90

- provides stimulatory feedback to CONTRAlateral cortex to modulate movement

Front 91

What are the output nerves from the cerebellum?

Back 91

- Purkinje fibers output to deep nuclei of cerebellum --> which in turn output to cortex via superior cerebellar peduncle

Front 92

What are the deep nuclei of the cerebellum?

Back 92

Lateral to Medial:
- Dentate
- Emboliform
- Globose
- Fastigial

"Don't Eat Greasy Foods"

Front 93

What does the lateral cerebellum control?

Back 93

- voluntary movement of extremities

Front 94

What does the medial cerebellum control?

Back 94

- balance
- truncal coordination
- ataxia
- propensity to fall toward injured (IPSIlateral) side

Front 95

In what areas is the basal ganglia important?
(2)

Back 95

- voluntary movements
- making postural adjustments

Front 96

SNc

Back 96

- Substantia nigra pars compacta

- part of the basal ganglia

Front 97

SNr

Back 97

- Substantia nigra pars reticulata

- part of the basal ganglia

Front 98

GPe

Back 98

- Globus pallidus externus

- part of the basal ganglia

Front 99

GPi

Back 99

- Glubus pallidus internus

- part of the basal ganglia

Front 100

STN

Back 100

- Subthalamic nucleus

- part of the basal ganglia

Front 101

D1

Back 101

- Dopamine D1 receptor
- excitatory

"D1-R = D1Rect pathway"

- part of the basal ganglia

Front 102

D2

Back 102

- Dopamine D2 receptor
- inhibitory

"Indirect = Inhibitory"

- part of the basal ganglia

Front 103

Excitatory pathway of the basal ganglia?

Back 103

Cortex (stimulates via glutamate) → Striatum (inhibits) → "SNr-GPi" complex (less inhibition of thalamus) → Thalamus (stimulates) → Cortex (stimulates) → Muscles, etc. → (hyperkinetic state)

- SNc's dopamine binds to D1 receptors in the excitatory pathway --> stimulating the excitatory pathway (increases motion)

- therefore, loss of dopamine in Parkinson's inhibits the excitatory pathway (decreased motion)

Front 104

Inhibitory pathway of the basal ganglia?

Back 104

Cortex (stimulates) → Striatum (inhibits) → GPe (less inhibition of STN) → STN (stimulates) → "SNr-GPi" complex (inhibits) → Thalamus (is stimulating less) → Cortex (is stimulating less) → Muscles, etc. → (hypokinetic state)

- SNc's dopamine binds to D2 receptors in the inhibitory pathway --> inhibiting the inhibitory pathway (double negative) (increased motion)

- therefore, loss of dopamine in Parkinson's excites (ie. disinhibits) the inhibitory pathway ( decreased motion)

Front 105

What is Parkinson's disease?

Back 105

- a degenerative disorder or CNS

Front 106

What is Parkinson's disease associated with (microscopically)?
(2)

Back 106

- Lewy bodies (composed of α-synuclein --> intacellular inclusion)

- depigmentation of the substantia nigra pars compacta (SNc) --> loss of dopaminergic neurons

Front 107

Rare cases of Parkinson's disease have been linked to what?

Back 107

- exposure to MPTP --> a contaminant in illicit street drugs

Front 108

What symptoms do you see in Parkinson's disease?
(4)

Back 108

"TRAP"

- Tremor (at rest -- ie. pill-rollong tremor)
- cogwheel Rigidity
- Akinesia
- Postural instability

"you are TRAPped in your body"

Front 109

What is hemiballismus?

Back 109

- sudden, wild flailing of 1 arm +/- leg

"Half ballistic (as in throwing a baseball)"

Front 110

What is hemiballismus characteristic of?

Back 110

- contralateral subthalamic nucleus lesion (ie. *lacunar stroke in pt. with a history of HTN*)

- loss of inhibition of thalamus through globus pallidus

Front 111

What is Huntington's disease?

Back 111

- an autosomal dominant trinucleotide repeat disorder
- expansion of CAG repeats (anticipation)

"CAG = Caudate loses Ach and Gaba"

Front 112

On what chromosome is the trinucleotide repeat found in Huntington's disease?

Back 112

Chromosome 4

Front 113

What happens in Huntington's disease?

Back 113

Neuronal death via:

- NMDA-R binding
- glutamate toxicity

Front 114

What symptoms do you see in Huntington's disease?
(3)

Back 114

- Chorea (quick movements of feet of hands)
- Depression
- Progressive Dementia

Front 115

When do symptoms manifest in Huntington's disease?

Back 115

- between the ages of 20 and 50

Front 116

What do you see on MRI in Huntington's disease?

Back 116

- atrophy of caudate nucleus (loss of GABA)
- atrophy of putamen

- enlarged lateral ventricles
- defined sulci

Front 117

What is chorea?

Back 117

- sudden, jerky, pruposeless movements (of hands and feet)

- Chorea = dancing (Greek)
"Think choral dancing or choreography"

Front 118

Chorea is characteristic of what?

Back 118

- basal ganglia lesion (ie. Huntington's)

Front 119

What is athetosis?

Back 119

- slow, writhing movements, especially of fingers

- Athetos = not fixed (Greek)
"Think snakelike"

Front 120

Athetosis is characteristic of what?

Back 120

- basal ganglia lesion (ie. Huntington's)

Front 121

What is myoclonus?

Back 121

- sudden, brief muscle contraction

- jerks, hiccups

Front 122

What is dystonia?

Back 122

- sustained, involuntary muscle contractions

- writer's cramp

Front 123

What is an Essential/Postural tremor?

Back 123

- action tremor (worsens when holding posture)

- autosomal dominant

- essential trmor pts. often self-medicate with alcohol, which decreases tremor

Front 124

What is the treatment for essential/postural tremor?

Back 124

- β-blockers

Front 125

What is a Resting tremor?

Back 125

- most noticeable distally
- seen in Parkinson's pts (pill-rolling tremor)

Front 126

What is an Intention tremor?

Back 126

- slow, zig-zag motion when pointing toward a target
- associated with cerebellar dysfunction

Front 127

Cerebral Cortex functions:
Frontal Lobe (4)

Back 127

- Motor speech (Broca's area; dominant hemishpere)
- Frontal eye fields
- Premotor area (part of extrapyramidal circuit)
- Principle motor area

Front 128

Cerebral Cortex functions:
Parietal Lobe (1)

Back 128

- Principal sensory areas

Front 129

Cerebral Cortex functions:
Occipital Lobe (1)

Back 129

- Prnicipal visual cortex

Front 130

Cerebral Cortex functions:
Temporal Lobe (2)

Back 130

- Primary auditory cortex (Heschl's gyrus)
- Associative auditory cortex (Wernicke's area; dominant hemisphere)

Front 131

What does the arcuate fasciculus connect?

Back 131

- Wernicke's area (associative auditory complex) and Broca's area (motor speech)

Front 132

Frontal Lobe functions
(9)

Back 132

"Executive Functions"

1. planning
2. inhibition
3. concentration
4. orientation
5. language
6. abstraction
7. judgement
8. motor regulation
9. mood

Front 133

What is most noticible symptom in frontal lobe lesions?

Back 133

- lack of social judgement

"Damage = Disinhibition (ie. Phineas Gage)"

Front 134

What is the homunculus?

Back 134

- a topographical representation of sensory and motor areas in the cerebral cortex

Front 135

What is the homunculus used for?

Back 135

- used to localize lesions (ie. in blood supply) leading to specific defects

- for example, lower extremity deficit in sensation or movement may indicate involvement of the anterior cerebral artery

Front 136

Brain Lesion Consequences:

Amygdala (bilateral)
(3)

Back 136

Kluver-Bucy syndrome:

- hyperorality
- hypersexuality
- disinhibited behavior

associated with HSV-1

Front 137

Brain Lesion Consequences:

Frontal Lobe
(5)

Back 137

- contralateral spastic paresis
-disinhibition
- deficits in concentration, orientation, and judgement
- may have reemergence of primitive reflexes
-can result in Broca's aphasia if dominant hemisphere

Front 138

Brain Lesion Consequences:

Right parietal lobe
(1)

Back 138

- Spatial neglect syndrome (agnosia of the contralateral side of the world)

Front 139

Brain Lesion Consequences:

Reticular activating system (midbrain)
(1)

Back 139

- reduced levels of arousal and wakefulness (ie. coma)

Front 140

Brain Lesion Consequences:

Mammillary bodies (bilateral)
(6)

Back 140

Wernicke-Korsakoff syndrome

- Wernicke --> confusion, ophthalmoplegia, ataxia, can be secondary to thiamine deficiency

- Korsakoff --> memory loss, confabulation, personality changes

Front 141

Brain Lesion Consequences:

Basal ganglia
(3)

Back 141

- tremor at rest
- chorea
- athetosis

Front 142

Brain Lesion Consequences:

Cerebellar hemisphere
(2)

Back 142

- intention tremor
- limb ataxia

- damage to the cerebemmum results in IPSI deficits
- fall toward side of lesion
- cerebellum --> SCP --> contralateral cortex --> corticospinal decussation = IPSI

"Cerebellar hemispheres are LATERALLY located --> affect LATERAL limbs"

Front 143

Brain Lesion Consequences:

Cerebellar vermis
(2)

Back 143

- truncal ataxia
- dysarthria

"Vermis is CENTRALLY located --> affects CENTRAL body"

Front 144

Brain Lesion Consequences:

Subthalamic nucleus
(1)

Back 144

- CONTRA hemiballismus

Front 145

Brain Lesion Consequences:

Hippocampus
(1)

Back 145

- anterograde amnesia (inability to make new memories)

Front 146

Brain Lesion Consequences:

Paramedian pontine reticular formation (PPRF)
(1)

Back 146

- eyes look AWAY from side of lesion

Front 147

Brain Lesion Consequences:

Frontal eye fields
(1)

Back 147

- eyes look TOWARD lesion

Front 148

What symptoms do you see in Central Pontine Myelinolysis?
(5)

Back 148

- acute paralysis
- dysarthria
- dysphagia
- diplopia
- loss of consciousness

Front 149

What commonly causes Central Pontine Myelinolysis?

Back 149

- very rapid correction of hyponatremia

Front 150

What happens with a recurrent laryngeal nerve injury?

Back 150

- loss of all laryngeal muscle except cricothyroid

Front 151

What symptom do you see in recurrent laryngeal nerve injury?

Back 151

- hoarseness

Front 152

What is aphasia?

Back 152

- higher-order inability to speak

Front 153

What is dysarthria?

Back 153

- motor inability to speak

Front 154

What is Broca's aphasia?

Back 154

- NONFLUENT aphasia with intact comprehension

"BROca's BROken BOCA"

left MCA superior division most often produces lesion

Front 155

Where is Broca's area?

Back 155

- inferior frontal gyrus of frontal lobbe

Front 156

What is Wernicke's aphasia?

Back 156

- FLUENT aphasia with impaired comprehension

"Wernicke's is Wordy but makes no sense!"

"Wernicke's = What?"

left MCA inferior division most often produces lesion

Front 157

Where is Wernicke's area?

Back 157

- superior temporal gyrus of temporal lobe

Front 158

What is global aphasia?

Back 158

- NONFLUENT aphasi with impaird comprehension

- BOTH Broca's and Wernicke's areas affected

Front 159

What is conduction aphasia?

Back 159

- poor repetition but FLUENT speech
- intact comprehension
- Arcuate fasciculus -- connects Broca's and Wernicke's areas

Front 160

What does the anterior cerebral artery supply?

Back 160

- supplies anteromedial surface

Front 161

What does the middle cerebral artery supply?

Back 161

- supplies lateral surface

Front 162

What does the posterior cerebral artery supply?

Back 162

- supplies posterior and inferior surfaces

Front 163

Associated area/deficit for:

Anterior spinal artery
(3)

Back 163

Medial medullary syndrome

- CONTRA hemiparesis (lower extremities)
- medial lemniscus (decreased CONTRA proprioception)
- IPSI paralysis of hypoglossal nerve

Front 164

Associated area/deficit for:

PICA
(12)

Back 164

Lateral medullay syndrome (aka Wallenberg's)

Nucleus ambiguous (CN IX, X, XI): IPSI paralysis of larynx, pharynx, palate -> dysarthria, dysphagia, loss of gag reflex

Spinal V- ipsilateral pain and temperature of face

Spinothalamic tract: CONTRA pain/temperature of body

Descending hypothalamics: IPSI Horner syndrome

- vertigo
- diplopia
- nystagmus
- vomiting
- IPSI ataxia

Front 165

Associated area/deficit for:

AICA

Back 165

Lateral inferior pontine syndrome

Facial nucleus and fibers: IPSI facial paralysis, loss of anterior 2/3 taste, lacrimation, salivation and corneal reflex, hyperacusis

Spinal trigeminal nucleus/tract: ipsilateral pain/temperature (face)

Contralateral pain/temperature loss body,

middle cerebellar peduncle: ipsilateral ataxia

vestibular nuclei: vertigo, nystagmus

Ipis horner's

Front 166

Associated area/deficit for:

Posterior cerebral artery
(1)

Back 166

- CONTRA homonymous hemianopia with macular sparing
- supplies occipital cortex

Front 167

Associated area/deficit for:

Middle cerebral artery
(3)

Back 167

- CONTRA face and arm paralysis and sensory loss
- aphasia (dominant sphere)
- left-sided neglect (nondominant lesion)

Front 168

Associated area/deficit for:

Anterior cerebral artery
(2)

Back 168

- supplies medial surface of the brain
- leg-foot area of motor and sensory cortices

Front 169

Associated area/deficit for:

Anterior communicating artery
(1)

Back 169

- lesion may cause visual field defects

Front 170

What is the most common site of circle of Willis aneurysms?

Back 170

Anterior communicating artery

Front 171

Associated area/deficit for:

Posterior communicating artery
(3)

Back 171

- common area of aneurysm

- causes CN III palsy - "down and out"

Front 172

Associated area/deficit for:

Lateral striate
(4)

Back 172

- divisions of middle cerebral artery

Supplies:
- internal capsule
- caudate
- putamen
- globus pallidus

"Arteries of Stroke"

Front 173

An infarct of the posterior limb of the internal capsule causes what?

Back 173

- pure motor hemiparesis

Front 174

Associated area/deficit for:

Watershed zones
(2)

Back 174

Between:
- anterior cerebral / middle cerebral
- posterior cerebral / middle cerebral

Front 175

Damage to watershed zones in severe hypotension leads to?

Back 175

- upper leg / upper arm weakness
- defects in higher-order visual processing

Front 176

Associated area/deficit for:

Basilar artery
(1)

Back 176

- infarct causees "locked-in syndrome"
- CN III is typically intact

Front 177

Associated area/deficit for:

in general, stroke of anterior circle
(2)

Back 177

- general sensory and motor dysfunction
- aphasia

Front 178

Associated area/deficit for:

in general, stroke of posterior circle
(4)

Back 178

Cranial nerve deficits
- vertigo
- visual deficits

- coma
- cerebellar deficits (ataxia)

- Dominant hemisphere --> ataxia
- Nondominant hemisphere --> neglect

Front 179

Where do Berry aneurysms occur?

Back 179

- at the bifurcations in the circle of Willis

Front 180

Most common site of Berry aneurysms?

Back 180

- the bifurcation of the anterior communicating artery

Front 181

Most common complication of Berry aneurysms and what that leads to?

Back 181

- Rupture --> leads to hemorrhagic stroke/subarachnoid hemorrhage

Front 182

What diseases/syndromes are Berry aneurysms associated with?
(3)

Back 182

- adult polycystic kidney disease
- Ehlers-Danlos syndrome
- Marfan's syndrome

Front 183

Other risk factors for Berry aneurysms?
(4)

Back 183

- advanced age
- HTN
- smoking
- race (higher risk in blacks)

Front 184

What are Charcot-Bouchard microaneurysms associated with?

Back 184

- chronic HTN

Front 185

What do Charcot-Bouchard microaneurysms affect?

Back 185

- small vessels (ie. in basal ganglia, thalamus)

Front 186

Epidural hematoma

Back 186

rupture of midle meningeal artery, often 2ndary to fracture of temporal bone
*lucid interval"

rapid expansion -> transtentorial herniation

CNIII palsy


CT shows "biconvex disk" not crossing duture lines, flax, tentorium

Front 187

Subdural hematoma

Back 187

rupture of bridging veins-> slow venous bleeding

seen in elderly individuals, alcoholics, blunt trauma, shaken baby (brain atrophy, shaking, whiplash)

crescent shaped hemorrhage that crosses suture lines, midline shift, gyri preserved, does not cross flax, tentorium

Front 188

Subarachnoid hemorrhage

Back 188

rupture of aneurysm (Berry), or AVM
rapid time course, "worse headache of my life"

bloody or yellow spinal tap

2-3 days afterward has risk of vasospasm due to blood breakdown (treat with nimodipine), and rebleed -> ischemia

Front 189

Intraparenchymal (HTNsive) hemorrhage

Back 189

most often systemic HTN, but also amyyloid angiopathy (Alzheimer's), vasculitis (DM), and neoplasm

typically in basal ganglia and internal capsule

Front 190

Ischemic brain disease

Back 190

irreversible damage after 5 minutes - most vulnerable hippocampus, neocortex, cerebellum, *watershed areas*

Front 191

Atherosclerosis in ischemic brain disease

Back 191

thrombi lead to ischemic stroke -> subsequent necrosis

cystic cavity with reactive gliosis

Front 192

Hemorrhagic stroke in ischemic brain disease

Back 192

intracerebral bleeding, often due to HTN, anticoagulation and cancer
2ndary to ischemic stroke: reperfusion of ischemic/damaged vessels

Front 193

Ischemic stroke

Back 193

emboli block large vessels, etiologies include A fib, carotid dissection, patent foraen ovale, endocarditis

lacunar strokes block small vessels, may be sndary to HTN

tPA within 4.5 hours

Front 194

Transient ischemic attack

Back 194

brief, reversible episode of neurologic dysfunction lasting fewer than 24 hours

Front 195

Dural venous sinuses

Back 195

cerebral veins -> venous sinuses -> internal jugular vein

Front 196

Ventricular system

Back 196

CSF made by choroid plexus, reabsorbed by venous sinus arachnoid granulations

lateral ventricles -> foramen of Monro/ventricular Foramen -> third ventricle -> cerebral aqueduct -> 4th ventricle -> subachnoid space (Lateral Foramina of Luschka, Medial foramen of Magendie)

Front 197

Normal pressure hydrocephalus

Back 197

Dementia, ataxia and urinary incontinence "Wet, wobbly, and wacky"
reversible cause of dementia in elderly

Increases subarachnoid volume but not CSF pressure-> distortion of corona radiata

Front 198

Communicating hydrocephalus

Back 198

decreased CSF reabsorption by arachnoid villi -> increased intracranial pressure, papilledema, herniation

Front 199

Obstructive (noncommunicating) hydrocephalus

Back 199

caused by a structural blockage of CSF circulation

Front 200

Hydrocephalus ex vacuo

Back 200

increase of CSF due to atrophy without an increase in pressure/damage

Front 201

Spinal nerves

Back 201

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Nerves C1-C7 exit above corresponding vertebra - all others below

Front 202

Dorsal column

Back 202

ascending pathway for fine touch, proprioception, vibration, pressure

receptor from body -> neuron body in DRG -> travels ipsilateral until synapsing in lower medulla -> decussates as internal arcuate fibers -> ascends as medial lemniscus -> synapses in VPL of thalamus -> 3rd order neuron goes to somatosensory cortex

Gracile fasciculus from lower extremities to gracile nucleus
Cuneate fasciculus from upper extremities to cuneate nucleus

ordered as you are with hands at sides -arms on outside, legs inside

Front 203

Lesions in dorsal column

Back 203

in spinal cord -> ipsilateral loss of function

above decussation (medulla) -> contralateral

Front 204

Anterolateral/spinothalamic tract

Back 204

ascending pathway for pain and temperature

1st neuron has cell body in DRG -> synapses in dorsal horn of spinal cord -> 2nd neuron immediately decussates -> ascends in lateral spinothalamic tract -> synapses in VPL -> 3rd neuron -> somatosensory cortex

Legs are lateral

Front 205

Lesions in anterolateral/spinothalamic tract

Back 205

contralateral loss of function

Front 206

Lateral corticospinal tract

Back 206

descending voluntary movement

Cortex -> posterior limb of internal capsule -> crus cerebri (midbrain) -> base of pons -> pyramids (medulla) -> pyramidal decussation -> lateral spinal corticospial tract -> ventral horn synapse -> muscle

cortex -> ventral horn = upper motor neuron
ventral horn -> muscle = lower motor neuron

Front 207

Upper motor neuron lesion

Back 207

everything is turned up

spastic paralysis, increased muscle tone, diuse atrophy, hyperreflexia, Babinski (toes go UP), clasp knife spasticity

Front 208

Lower motor neuron lesions

Back 208

everything is lowered

flaccid paralysis, hypotonia, muscle atrophy, hyporeflexia, no Babinski

Front 209

Poliomyelitis

Back 209

caused by polio virus -> oropharynx/small intestine symptoms -> travel to anterior horn of spinal cord -> LMN destruction

symptoms: malaise, headache, fever, nausea, abdominal pain, sore throat, LMN lesions

CSF with lymphocytic pleocytosis with slightly elevated protein, no change in glucose

virus present in stool/throat

Front 210

Werdnig-hoffman disease

Back 210

infantile spinal muscular atrophy: "floppy baby," tongue fasciculations, median death at 7 months

degeneration of anterior horns, LMN involvement
AR

Front 211

Amyotrophic lateral sclerosis

Back 211

both LMN and UMN signs; no sensory, cognitive, or oculomotor deficits

presents as fasciculations-> atrophy; progressive and fatal

can be caused by superoxide dismutase 1 defect

Riluzole can lengthen survival by decreasing presynaptic glutamate release

Front 212

Tabes dorsalis

Back 212

degeneration of dorsal columns and dorsal roots due to tertiary syphilis -> impaired proprioception and locomotor ataxia

Charcot's joints, shooting pain, Argyll Robertson pupil, absent DTRs, positive Pomberg, sensory ataxia at night (dark)

Front 213

Friedreich's ataxia

Back 213

AR trinucleotide repeat: GAA -> frataxin (mitochondria function)

staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy (death)

kids with kyphoscoliosis

Friedreich is Fratastic, he pledged GAA and is always stumbling, staggering, falling

Front 214

Brown-Sequard Syndrome

Back 214

hemisection of spinal cord

1. ipsilateral UMN signs below lesion (corticospinal tract)
2. Ipsilateral fine touch, vivration, proprioception below lesion (dorsal column)
3. contra pain and temperature loss below (spinothalamic tract)
4. Ipsilateral loss of all sensation at level
5. LMN signs at level of lesion

Front 215

Horner's syndrome

Back 215

1. Ptosis (superior tarsal muscle) 2. Anhidrosis 3. Miosis
loss of sympathetic innervation

Pathway: hypothalamus -> intermediolateral column 0> superior cervical ganglion -> pupil, smooth muscle of eyelids, sweat glands

Front 216

Reflexes

Back 216

Biceps = C5
Triceps = C7
Patella = L4
Achilles = S1

Front 217

Mororeflex

Back 217

"hang on for life" abduct/extend limbs when startled then draw together - normal disappear with 1st year

Front 218

Rooting reflex

Back 218

movement of head toward one side if cheek or mouth stroked (nipple seeking)

Front 219

Sucking reflex

Back 219

sucking response when roof of mouth is touched

Front 220

Palmar reflex

Back 220

curling of fingers when palm stroked

Front 221

Babinski reflex

Back 221

dorsiflexion of large toe and fanning of other toes with plantar reflex

up with UMN lesion

Front 222

Gallant reflex

Back 222

stroking one side of the spine while newborn in ventral suspension causes lateral flexion of lower body towards stimulated side

Front 223

Pineal gland

Back 223

melatonin secretion - circadian rhythms

Front 224

Superior colliculi

Back 224

conjugate vertical gaze center

lesion cause Parinaud syndrome - paralysis of conjugated gaze, can be due to pinealoma

Front 225

Inferior colliculi

Back 225

auditory

Front 226

Cranial nerves

Back 226

On Old Olympus's Towering Tops A Finn And German Viewed Some Hops


Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory vestibular (vestibulocochlear) Glossopharyngeal, Vagus, (Spinal) Accessory, Hypoglossal

Front 227

CN I

Back 227

olfactory nerve- smell
projections through cribriform plate

Front 228

CN II

Back 228

optic nerve
sight
exits through optic canal

Front 229

CN III

Back 229

Eye movements (SR, IR, MR, IO), pupillary constriction (PS: E-W nucleus, muscarinic R). accommodation, eyelid opening
exits through superior orbital fissure

Front 230

CN IV

Back 230

eye movement (SO)- downward gaze when eye is fully adducted (looking at nose)
exits through superior orbital fissure

Front 231

CN V

Back 231

Trigeminal

mastication, facial sensation (opthalmic, maxillary, mandibular division)
V1 branch exits through superior orbital fissure
V2 exits through foramen rotundum
V3; foramen ovale

Front 232

CN VI

Back 232

Eye movement (LR)
exits through superior robital fissure

Front 233

CN VII

Back 233

Facial nerve

facial movement, taste anterior 2/3 tongue, lacrimation, salivation, eyelid closing, stapedius muscle in ear (dampens sound)
exits through auditory canal (stylomastoid foramen)

Front 234

CN VIII

Back 234

vestibulocochlear

hearing and balance

exits through auditory canal

Front 235

CN IX

Back 235

glossopharyngeal
taste from posterior 1/3 tongue, swallowing, salivation (parotid), carotid body and sinus chemo/baroreceptors, and stylopharyngeus (elevates pharynx, larynx)

exits through jugular foramen

Front 236

CN X

Back 236

vagus
swallowing, palate elevation, midline uvula, talking, coughing, thoracoabdominal viscera, arotic arch chemo/baroreceptors
exits through jugular foramen

Front 237

CN XI

Back 237

spinal accessory nerve
head turning, shoulder shrugging

exits through jugular foramen (enters skull through foramen magnum)

Front 238

CN XII

Back 238

hypoglossal
tongue movement
exits through hypoglossal foramen (canal)

Front 239

Cranial nerve nuclei in midbrain

Back 239

CN III, IV

Front 240

Cranial nerves nuclei in pons

Back 240

CN V, VI, VII, VIII

Front 241

Cranial nerve nuclei in pmedulla

Back 241

CN IX, X, XI, XII

Front 242

Corneal reflex

Back 242

afferent V1 ophthalmic (nasociliary branch)
efferent VII (temporal branch : orbicularis oculi)

Front 243

Lacrimation reflex

Back 243

afferent V1, efferent VII

Front 244

Jaw jerk reflex

Back 244

V3 sensory from masseter
V3 motor to masseter

Front 245

Pupillary reflex

Back 245

afferent II, efferent III

Front 246

Gag reflex

Back 246

afferent IX, efferent IX, X

Front 247

Vagal nucleus Solitarius

Back 247

visceral sensory information (taste, baroreceptors, gut distention) for CN VII, IX, X

Front 248

Vagal nucleus ambiguus

Back 248

motor innervation of pharynx, larynx and upper esophagus, CN IX, X, XI

Front 249

Vagal dorsal motor nucleus

Back 249

parasympathetic fibers to heart, lungs, and upper GI

Front 250

Optic canal

Back 250

CN II, ophthalmic artery, central retinal vein

Front 251

Superior orbital fissure

Back 251

CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers

Front 252

Foramen rotundum

Back 252

CN V2

Front 253

Foramen Ovale

Back 253

CN V3

Front 254

Foramen spinosum

Back 254

middle meningeal artery

Front 255

internal auditory meatus

Back 255

CN VII, VIII

Front 256

jugular foramen

Back 256

CN IX, X, XI, jugular vein

Front 257

Hypoglossal canal

Back 257

CN XII

Front 258

Foramen magnum

Back 258

spinal roots CN XI, brain stem, vertebral arteries

Front 259

Cavernous sinus

Back 259

venous sinuses on either side of pituitary
blood from eye and superficial cortex -> cavernous sinus -> internal jugular vein

CN III, IV, V1, V2, and VI, and postganglionic sympathetic fibers to the orbit all pass through here

cavernous portion of internal carotid artery is also here

Front 260

Cavernous sinus syndrome

Back 260

ophthalmoplegia, ophthalmic and maxillary sensory loss

Front 261

Danger triangle of face

Back 261

edges of mouth to bridge of nose

potential for an infection to spread from here (ex. upper lip) to the brain via venous drainage
facial vein -> ophthalmic veins -> cavernous sinus

Front 262

CN XII LMN lesion

Back 262

tongue deviated towards side of lesion due to weakened muscles on affected side

Front 263

CN V motor lesion

Back 263

jaw deviates toward side of lesion due to unopposed force from opposite pterygoid muscle

Front 264

CN X lesion

Back 264

uvula deviates away from side of lesion - weak side collapse and uvula pulled away

Front 265

CN XI lesions

Back 265

weakness of turning head to contralateral side, shoulder droop on same side

Front 266

Conductive hearing loss

Back 266

abnormal Rinnne test (bone > air); Weber localizes to affected ear

Front 267

Sensorineual hearing loss

Back 267

normal Rinne test (air > bone); Weber test localizes to unaffected ear

Front 268

Facial nerve UMN lesion

Back 268

motor cortex or connection between cortex and facial nucleus
contralateral paralysis of lower face only; bilateral UMN innnervation of upper face

Front 269

Facial nerve LMN lesion

Back 269

Ipsilateral paralysis of upper and lower face

Front 270

Bell's palsy

Back 270

complete destruction of facial nucleus itself or its brachial efferent fibers

peripheral ipsilateral facial paralysis with inability to close eye on involved side

idiopathic -most recover
other causes: AIDS, Lyme disease, HSV, Sarcoidosis, Tumors, Diabetes

Front 271

Muscles of mastication

Back 271

3 muscles close: masseter, temporalis, medial pterygoid
1 opens: lateral pterygoid
all are innervated by trigeminal nerve V3

Front 272

Retinitis

Back 272

retinal necrosis + edema = atrophic scar
associated with CMV in AIDS patients

Front 273

Iritis

Back 273

due to systemic inflammation

Front 274

Near vision

Back 274

ciliary muscle contracts (zonular gibers relax -> lens relaxes -> more convex)
can't see far away

Front 275

Distant vision

Back 275

ciliary muscle relaxes (lens flattens)
can't see up close

Front 276

Aging of eye

Back 276

sclerosis and decreasing elasticity causes presbyopisa (no near vision)

Front 277

Retinal artery occlusion

Back 277

acute painless monocular loss of vision, pale retina and cherry-red macula (own blood supply -choroid artery)

Front 278

Open/wide angle glaucoma

Back 278

obstructed outflow (eg. Canal of Schlemm); myopia, increases with aging, African-American race
most often "silent" painless

Front 279

Closed/narrow angle glaucoma

Back 279

contact between lens and central iris forms seal - flow of normal fluid behind pupil messed up
very painful, impaired vision, rock-hard eye, frontal headache, ophthalmologic emergency
do not give epinephrine

Front 280

Cataract

Back 280

painless, bilateral opacification of lens - impaired vision

risk: age, smoking, EtOH, sunlight, classic galactosemia, galactokinase deficiency, DM, trauma, infection, steroids

Front 281

Papilledema

Back 281

increased intracranial pressure -> elevated optic disk with blurred margins-> blind spot

Front 282

Pupillary constriction

Back 282

pupillary spincter muscle (circular muscle), parasympathetic
CN III from Edinger-Westphal nucleus -> ciliary ganglion

Front 283

Pupillary dilation

Back 283

radial muscle (pupillary dilater muscle), sympathetic
T1 preganglionic sympathetic -> superior cervical ganglion -> postganglionic sympathetic -> long ciliary nerve

Front 284

Pupillary light reflex

Back 284

retina -> CN II -> pretectal nuclei in midbrain -> bilateral activation of E-W nucleui -> pupils contract bilaterally

Marcus gun pupil -> afferent pupillary defect -> decreased bilateral constriction when shone light in affected eye

Front 285

Retinal detachment

Back 285

separation of neursensory layer of retina from pigment epithelium -> degeneration of photoreceptors -> vision loss

Front 286

Age-related macular degeneration

Back 286

loss of central vision (scotomas)
dry/atrophic is slow. due to fat deposits
wet is rapid, due to neovascularization

Front 287

Right anopia

Back 287

lesion in optic nerve before optic chiasm

Front 288

bitemporal hemianopia

Back 288

lesion/compression in optic chiasm
located near pituitary gland, often from tumor

Front 289

Contralateral homonymous hemianopia

Back 289

lesions of optic tracts, can occur after optic chiasm, both temporal and parietal optic radiations, lateral geniculate nucleus
uncommon

Front 290

Contralateral superior quantrantopia

Back 290

"pie in the sky"
temporal lobe lesions often from MCA inferior division infarct interrupting lower optic radiations through temporal lobe, lower bank of calcarine fissure

Front 291

Contralateral inferior quantrantopia

Back 291

"pie on the floor"
MCA superior lesion infarct in the parietal lobe takes out upper optic radiations
PCA infarct takes out primary visual cortex, upper calcarine bank

Front 292

Macular sparing

Back 292

it's a thing

Front 293

Meyer's loop

Back 293

inferior retina -> loops around inferior horn of lateral ventricle
dorsal optic radiation - superior retina, takes shortest path via internal capsule

Front 294

Internuclear ophthalmoplegia

Back 294

lesion in medial longitudinal fasciculus -> medial rectus palsy on attempted lateral gaze
nystagmus in abducting eye
convergence normal
seen commonly in MS

Front 295

Dementia

Back 295

a decline in cognitive ability, memory, or function with intact consciousness

Front 296

Alzheimer's disease

Back 296

most common cause of dementia in elderly, Down's syndrome patients have increased risk

Familial form (10%)
early onset: APP (on chromosome 21), presenilin-1 (14), presenilin-2 (1)
later onset: ApoE4 (19)

ApoE2 is protective

widespread cortical atrophy: decreased ACh
senile plaques: extracellular beta-amyloid core, amyloid angiopathy -> intracranial hemorrhage
neurofibrillary tangles: intracellular, abnormally phosphorylated tau protein = insoluble cytoskeletal elements, correlate with degree of dementia

Front 297

Pick's disease

Back 297

frontotemporal dementia: dementia, aphasia, parkinsonian aspects, change in personality (temper, mean)
spares parietal lobe and posterior 2/3 superior temporal gyrus

Pick bodies: intracellular, aggregated tau protein
frontotemporal atrophy

Front 298

Lewy body dementia

Back 298

Parkinsonism with dementia and hallucinations
alpha-synuclein defect

Front 299

Creutzfeldt-jakob disease

Back 299

rapidly prgressive (weeks to months) dementia with myoclonus
spongiform cortex
prions -PrPc -> PrPsc sheet resistant to proteases

Front 300

Multiple sclerosis

Back 300

autoimmune inflammation and demyelination of CNS, optic neuritis; relapsing/remitting neuro symptoms separated by time and location

increased IgG protein in CSD, oligoclonal bands are diagnostic
MRi shoes periventricular plaques

ts: beta-interferon, immunosuppression, symptomatic

Front 301

Guillain-Barre syndrome

Back 301

bilateral ascending muscle weakness, facial paralysis in 50% of cases, autonomic function can be compromised

majority of patients recover completely after weeks to months

associated with infections -> autoimmune attack of peripheral myeline due to molecular mimicry: C. jejuni, herpesvirus, inoculations and stress

increased CSF protein with normal cell count

tx: respiratory support, plasmapheresis, IV IG

Front 302

Progressive multifocal leukoencephalopathy

Back 302

demyelination of CNS due to destruction of oligodendrocyte-> rapidly progressive, often fatal

associated with JC virus in AIDS patients

Front 303

Acute disseminated encephalomyelitis

Back 303

multifocal perivenular inflammation and demyelination after infection (chickenpox, measles) or certain vaccinations (rabies, smallpox)

Front 304

Metachromatic leukdystrophy

Back 304

AR lysosmal storage disease, most commonly arylsulfatase A deficiency, build up of sulfatides leads to impaired production of myelin sheath

ataxia, dementia

Front 305

Charcot-Maire-Tooth disease

Back 305

hereditary motor and sensory neuropathy: defective production of proteins invovled in structure and function or peripheral nerves or the myelin sheath

Front 306

Partial seizures

Back 306

localized to 1 area of the brain, most often from medial temporal lobe, ex. will just have one arm spasm
often has aura (smells, vision changes)
can secondarily generalize

simple partial - conciousness intact: motor, sensory, autonomic, psychic
complex partial (impaired consciousness)

Front 307

Generalized seizures

Back 307

more common than partial
1. absence - no postictal confusion, blank stare for a few seconds
2. Myoclonic - quick, repetitive jerks
3. tonic-clonic - alternating stiffening movement
4. tonic - stiffening
5. Atonic - "drop" seizures, commonly mistaken for fainting

Front 308

Status epilepticus

Back 308

recurring seizures without restoration of consciousness

requires benzodiazepines emergently then antiepileptics

Front 309

Causes of seizures in children

Back 309

genetic, infection (febrile), trauma, congenital, metabolic

Front 310

Causes of seizures in adults

Back 310

tumors, trauma, stroke, infection

Front 311

Causes of seizures in elderly

Back 311

stroke, tumor, trauma, metabolic, infection

Front 312

Treatment of seizures for pregnant women

Back 312

phenobarbital

Front 313

Migraine

Back 313

unilateral heache, 4-72 hours, pulsating pain with nausea, photophobia, phonophobia, +/- aura

irritation of CN V and release of substance P, GCRP, vasoactive peptides

tx: propranolo, NSAIDs, sumatriptan for acute migraines

Front 314

Tension headache

Back 314

unilateral; repetitive brief headaches, no photphobia, phonophobia, aura

Front 315

Cluster headaches

Back 315

unilateral, repetitive brief headaches, characterized by periorbital pain, ipsilateral lacrimation, rhinorrhea, Horners syndrome

males>>females

tx: inhaled O2, sumatriptan

Front 316

Vertigo

Back 316

illusion of movement,
peripheral- more common, inner ear etiology, postitional testing shows delayed horizontal nystagmus

central vertigo - brain stem or cerebellar lesion, positional testing shows immediate nystagmus in any direction, may change directions

Front 317

Meniere's diseae

Back 317

abrupt recurrent attacks of vertigo with deafness or tinnitus, unilateral, N/V

Front 318

Sturge-Weber syndrome

Back 318

congenital disorder with port-wine stains, typically in V1 ophthalmic distribution, ipsilateral leptomenigeal angiomas, pheochromocytomas

can cause glaucoma, seizures, hemiparesis, mental retardation

occurs sporadically

Front 319

Tuberous sclerosis

Back 319

HAMARTOMAS: hamartomas in CNS and skin, Adenoma sebaceum (cutaneous angiofibromas), Mitral Regurg, Ash-leaf spots, cardiac Rhabdomyoma, Tuberous sclerosis, autosomal dOminant, Mental retardation, renal Angiomyolipoa, Seizures

Front 320

Neurofibromatosis type I

Back 320

cafe-au-lait spots, Lisch nodules (pigmented iris hamartomase), neurofibromas in skin, optic gliomas, pheochromocytomas
AD with 100% penetrance but variable expression

mutated NF-1 gene on chromosome 17 (negatively regulates RAS pathway)

Front 321

von Hippel-Lindau disease

Back 321

cavernous hemangiomas in skin, mucosa, organs, bilateral renal cell carcinoma, hemangioblastoma in retina, brain stem, cerebellum, pheochromocytomas

AD, mutated tumor suppresor CHL on Chr3

Front 322

Majority of adult primary tumors are ____

Back 322

supratentorial

Front 323

Majority of adult primary tumors are ____

Back 323

infratentorial

infant-tentorial

Front 324

Most common type of brain tumor

Back 324

metastases: well circumscribed, present at gray-white junction

Front 325

Glioblastoma

Back 325

most common primary brain tumor with poor prognosis <1 yrs

cerebral hemispheres can cross corpus callosum

astrocytes stain for GFAP

"pseudopalisading" pleomorphic tumor cells, borer central areas of necrosis and hemorrhage

Front 326

Meningioma

Back 326

second most common primary brain tumor

often occurs in convexities of hemispheres and parasagittal region

arises from arachnoid cells external to brain

usually benign and resectable

plindeled cells concentrically arranged in a whorled pattern, psammoma bodies (laminated calcifications)

Front 327

Schwannoma

Back 327

Schwann cell origin
often localized to CN VIII, cerebellopontine angle
resectable,
S-100 positive

bilateral in NF-2

Front 328

Oligodendroglioma

Back 328

relatively rare, slow growing
most often in frontal lobes -> personality changes, seizures, temper

chicken wire capillary pattern

oligodendroctyes: "fried egg" cells - round nuclei with clear cytoplasm

often calcified

Front 329

pituitary adenoma

Back 329

most commonly prolactinoma; bitemporal hemianopia

hyper/hypopituitarism

Front 330

Pilocytic astrocytoma

Back 330

low grade, well circumscribed, in kids

most often found in posterior fossa

may be supratentorial, GFAP positive

benign, good prognsis

Rosenthal fibers -eosinophilic, corkscrew fibers

cystic and solid

Front 331

Medulloblastoma

Back 331

kids: highly malignant cerebella tumor
form of primitive neuroectodermal tumor
can compress 4th ventricle

small blue cells, radiosensitive, homer-wright rosettes

Front 332

Ependymoma

Back 332

kids: ependymal cell tumors most often in 4th ventricle

poor prognosis, kids

characteristic perivascular pseudorosettes, rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus

Front 333

Hemangioblastoma

Back 333

kids

most often cerebellar, assoicated with von H-L syndrome when with retinal ngiomas

can produce EPO -> polycythemia

foamy cells and high vascularity

Front 334

Craniopharyngioma

Back 334

kids
benign, confused with pituitary adenoma
most common childhood supratentorial tumor

remnants of Rathke's pouch, tooth enamle-like calcifications

Front 335

Uncal herniation

Back 335

ipsilateral dilated pupils/ptosis - stretching of CNIII
contralateral homonymous hemianopia - compression of ipsilateral cerebral artery
ipsilateral paresis- compression of contralateral crus cerebria (Kernohan's notch)
Duret hemorrhages - paramedian artery rupture - caudal displacement of brain stem

Front 336

Ring-enhancing lesions

Back 336

metastases (lung>breast>kidney>melanoma>GI), abscesses, toxoplamosis, primary CNS lymphoma

Front 337

Uniformly enhancing lesions

Back 337

metastaic lymphoma, meningioma, mets

Front 338

Heterogeneously enhancing lesion

Back 338

glioblastoma multiforme