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139 Cards in this Set
- Front
- Back
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brain tumor: germ cell tumor commonly seen in pineal region
overlie tectum of midbrain what syndrome does it cause? |
GERMINOMAS
common cause of Parinaud's syndrome cause obstructive hydrocephlus and aqueductal stenosis |
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2% of intracranial gliomas
of ependymal origin found at IV foramina inc ICP, positional headache,s drop attacks |
Colloid cysts of 3rd ventricle
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benign
2% gliomas most common brain tumors CSF over production may cause hydrocephalus occur in 4th>lateral>3rd ventricles |
choroid plexus papilloma
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most common pediatric intracranial tumor
contain pilocytic astrocytes and Rosenthal fibers benign tumors of childhood w/ good prognosis |
cerebellar astrocytoma
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7% of primary brain tumors
PNET 2nd most common posterior fossa tumor in children responsible for posterior vermis syndrome |
medulloblastomas
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abundant capillary blood vessels
foamy cells found in cerebellum found in cerebllum and retina 2% of primary intracranial tumors |
hemangioblastoma - VHL syndrome
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perivascular pseudorosetes
benign ependymal tubules most common spinal cord glioma most commonly found in 4th ventricle causes hydrocephalus solid blue cells radiosensitive |
ependymoma
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benign childhood tumor
confused w/ pituitary adenoma causes bitemporal hemianopia most common childhood supratentorial tumor |
craniopharyngioma
-calcifications is common (tooth-enamel-like) derived from Rathke's pouch |
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pseudopalisading pleomorphic tumor cells
border central areas of necrosis and hemorrhage can cross corpus callosum <1 yr life expectancy |
glioblastoma mutliforme = grade IV astrocytoma
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2nd most common primary brain tumor
occurs in convexities of of hemispheres and parsagittal region arises from arachnoid cells external to brain resectable |
meningioma
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spindle cells concentrically arranged in whorled pattern; psammoma bodies - laminated calcifications
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Meningioma
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relatively rare, slow growing
most often in frontal lobes chicken-wire capillary pattern fried egg cells |
oligodendroglioma
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most commonly prolactinoma
bitemporal hemianopia hyper or hypopituitarism are sequelae |
pituitary adenoma
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can produce EPO --> secondary polycythemia
foramy cells w/ high vascularity |
hemangioblastoma
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what levels are the white communicating rami?
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myelinated preganglionic sympathetic fibers
found from T1-T3 |
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angle jerk - cord?
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S-1
Gastrocnemius |
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knee jerk
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L2-L4
Quadriceps |
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biceps jerk
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C5 and C6
biceps |
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Forearm jerk
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C5 and C6
brachioradialis |
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triceps jerk
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C7 and C8
triceps |
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angle jerk - cord?
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S-1
Gastrocnemius |
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knee jerk
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L2-L4
Quadriceps |
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biceps jerk
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C5 and C6
biceps |
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Forearm jerk
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C5 and C6
brachioradialis |
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triceps jerk
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C7 and C8
triceps |
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dorsal column medial leminiscus pathway
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1st order neurons: located in DRG
2nd order: gracile and cuneate nuclei of caudal medulla (decussate) VPL nucleus project through posterior limb of internal capsule to postcentral gyrus which is primary somatosensory cortex |
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above sensory decussion,
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contralateral loss of DC modalities
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in spinal cord,
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transection results in ipsilateral loss of DC modalities
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receptors for DC-ML
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Pacini's and Messner's tactile corpuscles, joint receptors, muscle spindles, Golgi tendon organs
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receptors for AL pathways
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free nerve endings
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anterolateral 1-3rd order neurona
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1. DRF at all levels, project at axons to spinal cord through dorsolateral tract of LIssauer
2. found in dorsal horn, give rise to axons that decussate in ventral white commissure and ascend in contralateral lateral funiculus, terminate in VPS 3rd order found in VPL nucleus of thalamus project through posterior limb of internal capsule to primary somatosensory cortex |
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origin of lateral corticospinal tract
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layer V of cerebral cortex:
1. premotor cortex (Brodmann's area 6) 2. primary cortex (Brodmann's area 4) 3. primary sensroy cortex 4. arm face foot areas ermination of tract terminates contralaterally through interneurons on ventral horn motor neurons |
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transection of lateral corticospinal tract
above motor decussion at pyramids |
contralateral spastic paralysis and Babinski
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ransection of lateral corticospinal tract
in spinal cord |
transection result in ipsilateral spastric paresis and Babinski
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what is involved in sound localization
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superior olive
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auditory and vestibular system system is derived from
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otic vesicle which is a derivative of otic placode, thickening of surface ectoderm
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semicircular ducts respond to
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angular acceleration and deceleration of the head
contain hair cells in crist ampullaris respond to ENDOLYMPH FLOW |
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auditory and vestibular system system is derived from
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otic vesicle which is a derivative of otic placode, thickening of surface ectoderm
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semicircular ducts respond to
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angular acceleration and deceleration of the head
contain hair cells in crist ampullaris respond to ENDOLYMPH FLOW |
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static labyrinth utricle and saccule
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position of head w/ respect to linear acceleration ad pull of gravity
contain hair cells whose ciliar are embedded in otolithic membrane hair cells are bent toward the longest cilium --> frequency of snesory discharge increase |
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what CN has no precortical realy in the thalamus?
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olfactory nerve
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olfactory pathway
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1st order: project to mitral cells of olfactory bulb (principle cells) --> olfactory tract and lateral olfactory stria to primary olfactory cortex and amygdala (Broddman's 34)
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what dz consists of ipsileral anosmia, ipsilateral optic atrophy, contralateral papilledema
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Foster Kennedy syndrome
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Edinger-Westphal nucleus
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preganglionic parasymathetic fibers to ciliary ganglion of orbit through CN III
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Ciliary ganglion
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projects postganglionic parasympathetic fibers to sphincter muscle of iron and ciliary muscle
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uncal herniation compresses what nerve?
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CN III --> dilated fixed pupil, external strabismus (exotropia)
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DM palsy
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affects CN III
damages central fibers and spares pupilloconstrictors |
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what nerve?
extorsion of eye weakness w/ downward gaze VERTICAL DIPLOPIA incr when looking down head tilting head trauma |
CN IV paralysis
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what nerve causes this?
loss of general sensation from face and mucous membranes of oral and nasal cavities flaccid paralysis deviation of jaw to weak side paralysis of tensor tympani muscle loss of corneal reflex |
trigeminal
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characterized by recurrent paraoxysms of sharp stabbing pain in or more branches of nerve
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trigeminal neuralgia
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what nerve mediates
facial mvmts taste salivation lacrimation general sensation from external ear |
facial
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flaccid paralysis of muscles of facial expression
loss of corneal reflex, efferent limb loss of taste hyperacusis bell's palsy crocodile tears syndrome supranuclear facial palsy bilateral facial nerve palsies |
facial nerve lesions
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acoustic neuroma can lesion what nerve?
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cochlear nerve
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what nerve causes this?
loss of general sensation from face and mucous membranes of oral and nasal cavities flaccid paralysis deviation of jaw to weak side paralysis of tensor tympani muscle loss of corneal reflex |
trigeminal
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characterized by recurrent paraoxysms of sharp stabbing pain in or more branches of nerve
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trigeminal neuralgia
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what nerve mediates
facial mvmts taste salivation lacrimation general sensation from external ear |
facial
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flaccid paralysis of muscles of facial expression
loss of corneal reflex, efferent limb loss of taste hyperacusis bell's palsy crocodile tears syndrome supranuclear facial palsy bilateral facial nerve palsies |
facial nerve lesions
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acoustic neuroma can lesion what nerve?
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cochlear nerve
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what nerve causes this?
loss of general sensation from face and mucous membranes of oral and nasal cavities flaccid paralysis deviation of jaw to weak side paralysis of tensor tympani muscle loss of corneal reflex |
trigeminal
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characterized by recurrent paraoxysms of sharp stabbing pain in or more branches of nerve
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trigeminal neuralgia
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what nerve mediates
facial mvmts taste salivation lacrimation general sensation from external ear |
facial
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flaccid paralysis of muscles of facial expression
loss of corneal reflex, efferent limb loss of taste hyperacusis bell's palsy crocodile tears syndrome supranuclear facial palsy bilateral facial nerve palsies |
facial nerve lesions
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acoustic neuroma can lesion what nerve?
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cochlear nerve
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what nerve causes this?
loss of general sensation from face and mucous membranes of oral and nasal cavities flaccid paralysis deviation of jaw to weak side paralysis of tensor tympani muscle loss of corneal reflex |
trigeminal
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characterized by recurrent paraoxysms of sharp stabbing pain in or more branches of nerve
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trigeminal neuralgia
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what nerve mediates
facial mvmts taste salivation lacrimation general sensation from external ear |
facial
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flaccid paralysis of muscles of facial expression
loss of corneal reflex, efferent limb loss of taste hyperacusis bell's palsy crocodile tears syndrome supranuclear facial palsy bilateral facial nerve palsies |
facial nerve lesions
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acoustic neuroma can lesion what nerve?
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cochlear nerve
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what nerve causes this?
loss of general sensation from face and mucous membranes of oral and nasal cavities flaccid paralysis deviation of jaw to weak side paralysis of tensor tympani muscle loss of corneal reflex |
trigeminal
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characterized by recurrent paraoxysms of sharp stabbing pain in or more branches of nerve
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trigeminal neuralgia
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what nerve mediates
facial mvmts taste salivation lacrimation general sensation from external ear |
facial
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flaccid paralysis of muscles of facial expression
loss of corneal reflex, efferent limb loss of taste hyperacusis bell's palsy crocodile tears syndrome supranuclear facial palsy bilateral facial nerve palsies |
facial nerve lesions
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acoustic neuroma can lesion what nerve?
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cochlear nerve
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what nerve mediates
taste, salivation, swallowing, input from carotid sinus, carotid body |
CN IX
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what lesion?
loss of gag reflex hypersensitive carotid sinus (syncope) pharynx, tonsils, fauces, back of tongue loss of taste from posterior 1/3 of tongue |
CN IX
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what nerve innerv phonation, swallowing, elevation of palate, taste, cutaneous sensation from ear
innervates viscera of neck, thorax, abdomen |
vagus nerve
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what lesion? ipsileral paralysis of soft palate, pharynx, larynx, hoarsenss, dyspnea, dysarthria, dysphagia
loss of gag anesthesia of pharynx and laryngx aortic aneurysms and tumors complete laryngeal paralysis parasymp disturbances |
vagus
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medial medullary syndrome - what is affected?
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hypoglossal nucleus, flaccid hemiparalysis
medial leminiscus - contralateral loss of tactile and vibration corticospinal tract - ipsilateral spastic hemiparesis |
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what nerve mediates
taste, salivation, swallowing, input from carotid sinus, carotid body |
CN IX
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what lesion?
loss of gag reflex hypersensitive carotid sinus (syncope) pharynx, tonsils, fauces, back of tongue loss of taste from posterior 1/3 of tongue |
CN IX
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what nerve innerv phonation, swallowing, elevation of palate, taste, cutaneous sensation from ear
innervates viscera of neck, thorax, abdomen |
vagus nerve
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what lesion? ipsileral paralysis of soft palate, pharynx, larynx, hoarsenss, dyspnea, dysarthria, dysphagia
loss of gag anesthesia of pharynx and laryngx aortic aneurysms and tumors complete laryngeal paralysis parasymp disturbances |
vagus
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medial medullary syndrome - what is affected?
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hypoglossal nucleus, flaccid hemiparalysis
medial leminiscus - contralateral loss of tactile and vibration corticospinal tract - ipsilateral spastic hemiparesis |
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occlusion of paramedian br of basilar arteries causes what deficits?
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corticospinal - contralateral spastic hemiparesis
medial leminiscue - contralateral loss of tactile sensation abducent - lesions result in ipsilateral lateral rectus paralysis |
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occlusion AICA causes
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lateral inferior pontine syndrome
facial nucleus: ipsilateral facial nerve paralysis, loss of taste, anterior 2/3 of tongue, loss of lacrimation and salivation, loss of corneal and stapedial reflexes CN8: uilateral central deafness vestibular nerve lesion ipsilateral loss of pain and temp lesions result in ipsilateral limb gait dystaxia spinothalamic tract - lesions result in contralateral loss of pain and temp descending sympathetic tract |
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superior colliculus and pretectal area
paralysis of upward and downward gaze, pupillary disturbance, absence of convergence cerebral aqueduct - compression causes noncommunicating hydrocephalus |
Parinaud's
dorsal midbrain |
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CN III
corticospinal tracts: contralateral spastic paresis corticobulbar fibers: contralateral weakness of lower face, tongue, palate oculomotor nerve roots -complete ipsilateral oculomotor paralysis ptosis and fixation, dilation of ipsilateral pupil occur |
medial midbrain syndrome
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what causes violent contralateral flinging mvmts of one or both extremitis?
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subthalamic lesion
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AR, copper metabolism
chr 13 what are the clinical signs? |
choreiform or athetotic mvmt
rigidity wind-beating tremor lentiform nucleus copper deposition in limbus psychiatric sx: psychosis, personality disorder, dementia dx: low serum ceruloplasmin, elevated urinary excretion incr copper concentration |
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how do you treat Wilson's?
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penicillamine
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repetitive choreic mvmt that affect face, skin, trunk
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tardive dyskinesia
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how do you treat tardive dyskinesia?
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repetitive choreic mvmt that affect face and trunk
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what NT is found in the basal nucleus of Meynert?
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Ach
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dopamine is found in what nucleus of the hypothalamus?
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arcuate
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D1 receptors are postsynaptic
activates |
adenylate cyclase and excitatory
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D2 receptors are presynaptic and presynaptic
inhibits |
adenylate cyclase
antipsychotic drugs block D2 |
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transmitter of most postanglionic sympathetic neurons
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NE
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NE is found where in the brain?
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locus ceruleus
highest concentration most postsynaptic receptors of LC are b1 and b2 receptors that activate AC and are excitatory |
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5HT where is it found?
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Raphe nuclei of brain stem
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where are endorphins found?
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hypothalamus
endorphin is a powerful analgesic |
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where enkephalins found?
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play role in pain suppression
highest concentration in globus pallidus |
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how are dynorphins distributed?
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follows the distribution map for enkephalins
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NE is found where in the brain?
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locus ceruleus
highest concentration most postsynaptic receptors of LC are b1 and b2 receptors that activate AC and are excitatory |
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5HT where is it found?
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Raphe nuclei of brain stem
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where are endorphins found?
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hypothalamus
endorphin is a powerful analgesic |
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where enkephalins found?
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play role in pain suppression
highest concentration in globus pallidus |
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how are dynorphins distributed?
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follows the distribution map for enkephalins
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substance P
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pain transmission
highly concentrated in substantia nigra found in DRG and substantia gelatinosa decr in huntingtons |
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somatostatin
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anterior hypothalamus projectaxons to median eminence
regulates release of growth hormone and TSH concentrated in neocortex and hippocampus reduced in Alzheimers incr in huntingtons |
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what inhibitory neurotransmitter include
stellate, basket, golgi cells of cerebellar cortex |
GABA
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major inhibitory NT of spinal cord
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glycine
used in Renshaw cells |
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major excitatory transmitter of brain
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glutamate
transmitter of granular cells transmitter of cerebellar granule cells nociceptive large primary afferent fibers corticobulbar and corticospinal tracts |
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NMDA receptors
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glutamate plays a role in long term potentiation of hippocampal neurons (memory process)
role in kindling and subsequent seizure activity |
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converts arginine to citrulline
responsible for SM relaxation of corpus cavernosum and hus penile erection play a role in memory formation? nitrovasodilatory in CV |
NO
found in olfactory, striatum, neocortex, hippocampal formation, supraoptic nucleus, cerebellum |
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degeneration of pars compacta of SN
reduction of dopamine in striatum and substantia nigra |
Parkinson's
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what are the 6 layers of the neocortex?
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1. molecular
2. external granular 3. external pyramidal 4. internal granular 5. internal pyramidal 6. multiform |
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tuberous sclerosis
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Hamartomas
Angiomyolipomas cardiac rabdomyoma renal angiomyolipoma subepndymal giant cell astrocytoma mitral regurgiation seziures hypopigmented ash leaf spots sebaceous adenoma shagreen patch Autosomal dominant with variable expressivity |
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neurofibromatosis I
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von recklinghausen's disease
Cafe au lait spots neurofibromas in skin from Schwann cells (neural crest) lisch nodules PHEOchromocytomas (will present w/ hypertension) optic gliomas mutated NF-1 gene AD |
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Von-Hippel Lindau
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cavernous hemangiomas in skin, mucosa, organs
bilateral renal cell carcinoma hemangioblastoma in retina brain stem cerebellum pheochromocytoma AD, mutated tumor suppressor VHL on Chr 3 |
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What are duret hemorrhages?
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develop in midbrain and pons due to medial temporal lobe herniation
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what disease has thinning of the ventral roots?
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ALS
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what in HIV patients causes lytic infection of oligodendrocytes leading to CNS demyelintion
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PML caused by JC virus
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what contains Rosenthal fibers?
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astrocytomas
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what disease has
exercise intolerance develops headaches and vomiting followed by generalized tonic-clonic seizures and hemiplegia elevated serum lactate and creatine kinase remote infarction |
MELAS mitochondrial encephalopathy w/ lactic acidosis and strokelike episodes
shows ragged ref fiber subsarcolemmal aggregates of mitochondira paracrystalline parking lot inclusion in cristae |
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what is the genetic basis for MELAS?
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mitochondrial genoms is a small circular DNA strand codingfor 22 mitochondrial-specific tRNAs and 2rRNAs species
leads to inefficient ATP get migraine headaches |
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3 yr old w/ lifelong failure to thrive now presents w/ learning disabilities, hearing probe, external ophthalmoplegia and weakness w/ hypotonia
what is the dx? |
mitochondrial myopathy
maternal pattern of inheritance b/c mtDNA is passed to offspring only via mitochondria provided by ovum all embryonic mitochondria are maternal in origin |
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what disease?
progressive muscle weakness elevated serum creatine kinase hand weakness, marked atrophy of facial and neck muscled dilated cardiomyopathy, CHF visual difficulty w/ cataracts in nearly every case, gonadal atrophy and frontal balding are frequent glucose intolerance occurs some pts develop dementia |
myotonic dystrophy
chains of central nuclei are seen ongoing expansion of CTG triple nucleotide repeats in successive generations- genetic process called anticipation |
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what disease?
note variation in size of muscle fibers, markedly diminished dystrophin |
Becker's is a milder for of DUchenne
onset is layer in adult life striated muscle have denegeration and regeneration |
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what disease has:
proximal muscular weakness difficulty climbing stairs or lifting objects fine muscle mvmt and deep tendon reflexes serum creatin kinase is elevated |
polymyositis
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in polymyositis, muscle biopsy shows
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lymphocytic infiltration w/ necrosis and regeneration of muscle fibers
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what kills the myocytes in polymyositis
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like other autoimmune disease, cytokine CD8+ T lymphocytes can cause myocyte killing
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what antibodies are present in polymyositis?
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Anti-Jo-1
anti-nuclear antibody anti-tRNA synthetase antibodies are specific not have clear cut causal role in this disease |
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what disease?
asymmetric muscular weakness involving distal muscle groups including knee extensors and wrist flexors? |
inclusion body myositis
rimmed vacuoles withim muscle fibers variation in fiber size and fibrous replacement typical for myopathic disease what |
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what do you see on EM for inclusion body myositis?
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filamentous inclusions that contain amyloid and hyperphosphorylated tau proteins
intracellular beta-amyloid deposits, amyloid fibrils and hyperphosphorylated tau suggest an aging phenomenon CD8+ T cells are found in lesions lack of response to immunosuppressive therapy suggests it is no autoimmune in origin |
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what is a small round blue cell found in the eye
it is familial and usually bilateral? |
retinoblastoma
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where are the favored sites of metastases for retinoblastoma?
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brain and bone marrow
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where does melanoma usually arise in the eye?
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UVEA - composed of irin, choroid, ciliary body
retinal detachment can occur suddenly |
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diabetic retinopathy
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loss of pericytes with aneurysm formation and basement membrane changes as a consequence
there is edema, retinal exudates, soft microinfarcts or hard yellowish exudates composed of deposits of plasma proteins and lipids |
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what is a pterygium?
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area of elastosis and basophilic degeneration of substantia propria collagen
assoc w/ advanced age and environment/solar exposure over a lifetime |
