Neuro

Front 1

intracranial hemorrhage that:
-does not cross suture lines.
-can cross falx, tentorium

rupture of?

Back 1

epidural hematoma

*rupture of middle meningeal a, can cause transtentorial herniation and CNIII palsy.

Front 2

crescent shaped hemorrhage that crosses suture lines. gyri is preserved since pressure is distributed equally.

cannot cross falx, tentorium

rupture of?

Back 2

subdural hematoma = rupture of bridging veins.

*delayed onset of symptoms

-seen in elderly, alcoholics, blunt trauma, shaken baby, whiplash

Front 3

risk after subarachnoid hemorrhage

Back 3

1-3 days after- risk of vasspasm due to blood breakdown products.

rx: nimlodipine (calcium channel blockers)

*the vasospasm can cause focal neuro deficits and doesn't show up on CT

Front 4

lobar strokes all over the brain - usally in basal ganglia and internal capsule.

cause?

Back 4

parenchymal hematoma: caused by hypertension, amyloid angiopathy.

Front 5

recurrent lobar hemorrhages, associated with advanced age, in cerebral hemispheres

Back 5

cerebral amyloid angiopathy

smaller and less severe compared to hypertensive hemorrhage

Front 6

focal neuro deficits + small amounts of bleeding in basal ganglia, internal capsule, pons

Back 6

charcot bouchard psuedoaneurysms

pathogenesis: long standing HTN --> hyaline arteriolosclerosis --> dilation (pseduoaneurysm) --> small amounts of bleeding

*it does have blood in the subarachnoid space but it does not have the "worst headache" symptoms like saccular hematoma.

Front 7

how long does it take for irreversible damage in the brain?

Back 7

5 minutes

Front 8

what are the findings in the brain after ischemia for:
1/2 day - 2 days:
day 2 - 3:
day 3 - 5:
week 1 - 2:
> 2 weeks:

Back 8

1/2 day - 2 days: red neurons (sign of irreversible injury)
day 2 - 3: necrosis and neutrophils
day 3 - 5: macrophages
week 1 - 2: reactive gliosis + vascular proliferation (see liquefactive necrosis)
> 2 weeks: glial scar

Front 9

How does a stroke appear on:
MRI:
Noncontrast CT:

Back 9

How does a stroke appear on:
MRI: bright within 3-30 mins
Noncontrast CT: bright on noncontrast in ~24 hrs

*bright indicates hemorrhage - so tPA is contraindicated

Front 10

When do you use tPA in ischemic brain disease?

Back 10

Use tPA in an ischemic stroke- when emboli block large vessels (can be secondary to a fib, endocarditis, PFO)

Also used in lacunar infarcts (HTN --> block small vessels of basal ganglia, pons, internal vapsule)

DO NOT use if there is hemorrhage (aka bright areas on noncontrast CT)

Front 11

microscopic findings in an ischemic neuron:

Back 11

shrinking of neuronal body
deep eosinophilia of cytoplasm
pyknosis of nucleus (shrinking)
loss of Nissl substance

Front 12

How would a neuron appear, microscopically, after the axon is severed?

Back 12

round, swollen nucleus 1-2 days post cut
peripherally located nuclei
granular Nissl substance

Front 13

Lateral ventricle --> 3rd ventricle via ____.
3rd ventricle --> 4th ventricle via ___.
4th ventricle --> subarachnoid space via (3)

Back 13

foramen of monro
cerebral aqueduct
foramina of luschka - 2- (lateral), magendie (medial)

Front 14

dementia, ataxia, urinary incontinence

Back 14

normal pressure hydrocephalus - expansion of ventricles distorts fibers of corona radiata, but NO increase in subarachnoid space volume.

*a reversible cause of dementia in elderly

Front 15

decreased CSF absorption in arachnoid villi

Back 15

communicating hydrocephalus - leads to increase intracranial pressure, papilledema, and hernation

Front 16

hydrocephalus ex vacuo

Back 16

ventricular enlargement occurs secondary to atrophy of the brain (alzheimers, HIV, Pick's)

Intracranial pressure is normal; triad is not seen.

Front 17

where does spinal cord end?

where does subarachnoid space end?

What is the region between these two points?

Back 17

spinal cord ends @ L2

subarachnoid space ends @ S2

L3-L5 = region to perform a lumbar puncture

*to do epidural (saddle block) you go under S2 (no subarachnoid)

Front 18

In the dorsal columns, where are the arms and legs represented?

Back 18

arms = lateral, legs = medial (just as you are oriented)

Front 19

In the corticospinal tract and spinothalamic tract, where are the arms and legs represented?

Back 19

legs= lateral in Lateral corticospinal tract and spinothalamic tract

arms = medial

Front 20

floppy baby + tonge fasciculations

median age of death = 7 mo

Back 20

Werdnig-Hoffman disease - presents as "floppy baby"

degeneration of anterior horns- LMN involvement only.

Front 21

pathogenesis of amytropic lateral sclerosis

Rx?

Back 21

defect in superoxide dismutase 1 --> free radical injury of neurons

Rx = riluzole which decreases presynaptic glutamate release (excitatory neurotransmitter)

*starts distal --> proximal, no sensory/cognitive loss

Front 22

5 major symptoms of tabes dorsalis

Back 22

1. impaired proprioception + locomotor ataxia
2. shooting lightening pain "Charcot's joints"
3. no DTRs
4. positive romberg
5. eyes accomodate but do not react to light

Front 23

10 yo presents with:
-ataxia of all 4 limbs
-skeletal abnormalitis: pes cavus, hammer toes, kyphoscoliosis
-hypertrophic cardiomyopathy

What are the 3 CNS regions degenerated?

Back 23

Friedreich's ataxia

degeneration of:
- spinocerebellar degeneration
- dorsal column
- sensory cells of dorsal root ganglia

Front 24

5 symptoms of Brown Sequard syndrome

Back 24

1. ipsilateral UMN signs below lesion
2. ipsilateral proprioception signs below lesion
3. contralateral pain/temp signs below lesion
4. ipsilateral loss of all sensation at level
5. LMN signs at level of lesion

Front 25

Landmark dermatomes:
C2, C3, C4

Back 25

C2 = posterior half of skull cap
C3 = high turtleneck shirt
C4 = low-collar shirt

Front 26

What dermatomes are
- at the nipple
- at the umbilicus
- at the inguinal ligament
- along the knee caps
- penis and anal zones

Back 26

What dermatomes are
- at the nipple: T4
- at the umbilicus: T10
- at the inguinal ligament: L1
- along the knee caps: L4
- penis and anal zones: S2,3,4

Front 27

What nerve roots are being tested with the following reflexes:
-Biceps
-Triceps
-Patella
-Achilles

Back 27

What nerve roots are being tested with the following reflexes:
-Biceps: C5
-Triceps: C7
-Patella: L4
-Achilles: S1

Front 28

Which CNs lie medially at the brainstem?

Back 28

CN 3 (oculomotor), 6 (abducens), 12 (hypoglossal)

Front 29

what does the superior and inferior colliculi responsible for?

Back 29

superior = conjugate vertical gaze center
inferior = auditory

Front 30

parinaud syndrome

4 characteristics

Back 30

paralysis of conjugate vertical gaze due to lesion in superior colliculi (pinealoma - possibly germinoma which secretes hormones)

-upward gaze palsy
-absent pupillary light reflex
-failure of convergence
-wide based gait

Front 31

what is the only CN without thalamic relay to cortex?

Back 31

olfactory CN I

Front 32

what are the functions of V1, V2, V3 trigeminal nerves

Back 32

V1 = opthalmic - sensory
V2 = maxillary - sensory
V3 = mandibular - sensory (tongue, tensor tympani, external ear) and motor (mastication) - V3 does BOTH motor and sensory

Front 33

what CN opens eyelid, which closes eyelid

Back 33

opens = CN3 (levator palpebrae)
close = CN7 (orbicularis oculi)

Front 34

Tongue innervation:
anterior 2/3: taste, sensation

Posterior 1/3 taste, sensation

Tongue root/pharynx = taste, sensation

Back 34

anterior 2/3: taste = CNVII, sensation = CNV3 mandibular

Posterior 1/3 taste, sensation = CNIX

Tongue root/pharynx = taste + sensation = CNX

Front 35

Ear innervation:

external ear: (2)
middle ear muscles: stapedius, tympanic membrane
inner ear: tensor tympani

Back 35

external ear: CNX (posterior), CNV3

middle ear muscles: CNVII stapedius, CNIX tympanic membrane

inner ear: CNV3 - tensor tympani

Front 36

6 functions of facial nerve (CNVII)

Back 36

1. facial movement - saying "ma"
2. taste from anterior 2/3 tongue
3. lacrimation
4. salivation (submandibular, sublingual)
5. eyelid closing (orbicularis oculi)
5. stapedius muscle in ear - damage causes hyperaccusis

Front 37

6 functions of glossopharyngeal nerve (CNIX)

Back 37

1. taste and sensory from posterior 1/3 of tongue.
2. swallowing
3. salivation (parotid glands)
4. carotid receptors
5. stylopharyngeus (elevates larynx, pharynx) + gag reflex
6. tympanic membrane sensation

Front 38

8 functions of Vagus n (CNX)

Back 38

1. sensation and taste from epiglottic region
2. swallowing
3. palate elevation
4. midline uvula
5. talking
6. coughing
7. thoracoabdominal viscera
8. aortic arches

Front 39

what cranial nerves are in the:
midbrain
pons
medulla

Back 39

midbrain: 3,4
pons 5-8
medulla 9-12

Front 40

what 3 things exit the optic canal

*part of the middle cranial fossa- through sphenoid bone

Back 40

CNII, opthalmic artery, central retinal vein

*opthalmic vein exits via the superior orbital fissure

Front 41

what exits the superior orbital fissure (6 things)

Back 41

CN III, IV, V1, VI (all the eye movers)
opthalmic vein
sympathetic fibers

Front 42

what exits the:
foramen rotundum
foramen ovale
foramen spinosum

Back 42

foramen rotundum - CN V2 (maxillary)
foramen ovale - CN V3 (mandibular)
foramen spinosum - middle meningeal artery

Front 43

Posterior cranial fossa goes through temporal or occipital bone:

what goes through:
internal auditory meatus:
jugular foramen:
hypoglossal canal:
foramen magnum:

Back 43

Posterior cranial fossa goes through temporal or occipital bone:

what goes through:
internal auditory meatus: CN VII(stapedius), VIII
jugular foramen: IX, X, XI jugular vein
hypoglossal canal: CN XII
foramen magnumL spinal roots of CN XI, brain stem, vertebral arteries

Front 44

cavernous sinus syndrome

Back 44

opthalmoplegia, opthalamic and maxillary sensory loss

Front 45

what 5 CNs travel through cavernous sinus?

Back 45

CN III, IV, V1, V2, VI

plus blood from the eye and superficial cortex --> cavernous sinus --> internal jugular vein

*all the muscles of the eye + sensory of the eye (V1) and maxilla (V2)

Front 46

CN XII lesion

Back 46

tongue deviates toward side of lesion

(tongue on injured side is atrophic)

Front 47

CN V lesion

Back 47

jaw deviates toward side of lesion (lesion side is weak, muscle contracts toward that side)

Front 48

CN X lesion

Back 48

uvula deviates away from side of lesion, weak side collapses and uvula points away.

Front 49

CN XI lesion

Back 49

weakness turning head to contralateral side of lesion (SCM). shoulder droop on side of lesion (trapezius)

Front 50

Facial UMN lesion

Back 50

contralateral paralysis of lower face only

Front 51

facial LMN lesion

Back 51

ipsilateral paralysis of upper and lower face

Front 52

Bell's palsy (4 potential complications)

Back 52

complete destruction of facial nerve with inability to close eye on involved side
-also can get hyperacusis (no stapedius innervation), decrease in salivation (submandibular, sublingual), loss of taste on ant 2/3 tongue

Front 53

6 causes of Bell's palsy

Back 53

AIDS
Lyme disease
Herpes simplex
sarcoidosis
tumors
diabetes

Front 54

Kuh
La
Mi

Back 54

Kuh = CN X (palate elevation)
La = CN XII (tongue)
Mi = CN VII (facial)

Front 55

what 3 muscles close jaw
what muscle opens jaw

Back 55

3 closers: masseter, temporalis, medial pterygoid

1 open: lateral pterygoid

*all innervated by CN V3

Front 56

damage to R. Meyer's loop (temporal lobe - MCA) will cause what visual field defect?

Back 56

left upper quadrantic anopia

*meyer's loop loops around the inferior horn of the lateral ventricle

Front 57

damage to R. dorsal optic radiation (parietal lobe - MCA) will cause what visual field defect?

Back 57

left lower quadrantic anopia

Front 58

damage to upper section of the calcarine fissure - PCA - will cause what visual field defect?

Back 58

left hemianopia with macular sparing

Front 59

Patient with MS has right MLF damage.

how would the right and left eye appear when trying to look LEFT.

Back 59

Right eye = doesn't move, medial rectus palsy- cannot adduct (look left)

Left eye = right-beating nystagmus

*essentially you have: medial rectus palsy on side affected, and nystagmus in (ajacent) abducting eye.

Remember, the MLF connects one CN VI nuclei to the adjacent eye's CN III so that when you adduct one eye, the other one will abduct.

Front 60

What are the 3 genes for early onset alzheimers?

what is the gene for late onset alzheimers?

Back 60

Early onset:
APP (21)
presenilin-1 (14)
presenilin-2 (1)

Late onset = Apo E4 (19)

Bad "4" you

*APP, presenilin are thought to promote production of AB-amyloid

Front 61

what is the protective gene for alzheimers

Back 61

ApoE2 (19) is protective

you're going "2" be fine

Front 62

3 gross path findings in alzheimers?

Back 62

1. widespread cortical atrophy - esp. hippocampus/nucleus basalis (where ACh is made)

2. senile plaques (AB-amyloid) --> may cause amyloid angiopathy --> intracranial hemorrhage (sudden death), recurrent lobar hemorrhage

3. neurofibrillary tangles (intracellular abnormally phopshorylated tau protein) = insoluble cytoskeletal elements. tangles correlate with degree of dementia.

Front 63

dementia, aphasia, parkinsonian aspects, change in personality.

Back 63

Pick's disease (frontotemporal dementia)

*see pick bodies = intracellular, aggregated tau protein

Front 64

Parkinsonism + dementia + hallucination = ?

what histological finding is key?

Back 64

Lewy Body Dementia

Lewy body = alpha synuclein defect

Front 65

Rapidly progressive (weeks - months) dementia with myoclonus = ?

Back 65

Creutzfeldt Jakob disease

Front 66

spongiform cortex (bubbles and holes in neurons of gray matter)

Back 66

Creutzfeldt Jakob disease

Front 67

5 clinical syndromes of multiple sclerosis

Back 67

1. optic neuritis - visual disturbances, central scotoma (macular damage), painful eye movements.

2. internuclear opthalmoplegia: MLF is demylinated and damaged --> adduction (medial rectus) paralysis + other eye has abduction nystagmus

3. Cerebellar dysfunction - tremor, ataxia, nystagmus

4. motor sensory symptoms: incontinence, hemiparesis, fatigue (most common symptom), scanning speech (sound drunk)

Front 68

Patient presents with scanning speech, intention tremor, and nystagmus.

Rx?

Back 68

Multiple sclerosis rx = beta-interferon (chronic), prednisone (for acute relapses)

Front 69

endoneural inflammatory infiltrate with lymphocytes and macrophages.

how does the weakness present?
what is treatment?

Back 69

Guillan Barre: autoimmune attack of peripheral myelin (segmental demyelination of LMNs) due to molecular mimicry (c. jejuni, herpes)

Rx: respiratory support (can cause autonomic dysfunction- cardiac irregularities, hypotension), plasma pharesis, IV immunoglobulins

*almost all patients survive in weeks-months

Front 70

Progressive multifocal leukoencephalopathy

Back 70

destruction of oligodendocyres --> demyelination of CNS.

Associated with JC virus reactivation. In AIDS, usually fatal.

Front 71

Acute disseminated (postinfectious) encephalomyelitis

Back 71

inflammation + demyelination after chickenpox (HSV-3), measles or rabies/small pox vaccine

*SSPE = abormal measles (rubeola) virus that persists in CNS --> dementia, spasticity, seizures.

Front 72

Charcot Marie Tooth disease

Back 72

defective production of proteins used in peripheral nerves or myelin --> motor + sensory neuropathy.

*see weakness of foot dorsiflexion from involvement of perineal nerve

Front 73

Patient with verigo has positional testing and shows DELAYED horizontal nystagmus.

where is the etiology located?

Back 73

peripheral vertigo = inner ear etiology (semicircular canal debris, vestibular n infection, Meniere's disease)

Front 74

Patient with verigo has positional testing and shows IMMEDIATE horizontal nystagmus.

where is the etiology located?

Back 74

central vertigo = brain stem or cerebellar lesion (vestibular NUCLEI, posterior fossa tumor)

Front 75

triad for sturge-weber

Back 75

1. port wine stain
2. ipsilateral leptomeningeal angiomas
3. pheochromocytomas

Front 76

patient with mental retardation, seizures, ash leaf spots and sebacious adenoma.

what 4 types of TUMORS are they at risk for?

Back 76

1. hamartomas in CNS, skin, organs.

2. cardiac rhabdomyoma

3. renal angiomyolipoma

4. subependymal giant cell astrocytoma

Front 77

4 tumors in von hippel lindau

Back 77

1. cavernous hemangiomas in skin, mucosa, organs

2. bilateral renal cell carcinoma

3. hemangioblastoma in retina, brain stem, cerebellum

4. pheochromocytoma

Front 78

3 most common primary brain tumors in adults

Back 78

1. glioblastoma multiforme
2. meningioma - arises from arachnoid cells, resectable.
3. schwannoma- often CNVIII, resectable, @ cerebellopontine angle; S-100 positive.

Front 79

pathologic findings of pilocytic (low grade) astrocytoma (most common pediatric brain tumor- benign good prognosis)

Back 79

rosenthal fibers - esopinophilic, corkscrew fibers.

gross - cystic and solid.

foudn in posterior fossa but may be supratentorial.

Front 80

highly malignant cerebellar tumor with rosettes and perivascular psuedorosettes.

Back 80

medulloblastoma - histo see small blue cells (this is a PNET tumor =primitive neuroectodermal tumor)

radiosensitive.

*since its located in the cerebellum, it can compress the 4th ventricle --> hydrocephalus

Front 81

childhood tumor found INSIDE the 4th ventricle

see what 2 findings histologically?

Back 81

ependymoma - poor prognosis.

see perivascular psuedorosettes and rod-shaped blepharoplasts near nucleus.

Front 82

craniopharyngioma
-presentation
-histology

Back 82

childhood equivalent of prolactinoma- often calcified and filled with thick brown fluid rich with cholesterol crystals

Front 83

4 signs of uncal hernation

Back 83

1. ipsilateral dilated pupil/ptosis - stretching of CNIII

2. contralateral homonymous hemianopia - compression of ipsilateral posterior cerebral artery

3. ipsilateral paresis - compression of contralateral crus cerebri

4. paramedian artery rupture from caudal displacement of brainstem.