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177 Cards in this Set
- Front
- Back
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What are the three main lesions of the brainstem?
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Anterior Spinal and PICA occlusion, and Medial Longitudnal Fasiculus Syndrome
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What is the most common lesion of the Midbrain?
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Weber's syndrome
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What areas of the brainstem does an occlusion in either PICA or Ant. Spinal affect?
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Medulla
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Which medullary syndrome is caused by occlusion of Anterior Spinal?
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Medial Medullary Syndrome
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What is in the medial medulla (medial medullary syndrome)?
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Coticospinal tract, Medial leminiscus, and Hypoglossal nucleus
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What occlusion causes the lateral medullary syndrome?
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PICA occlusion
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What 6 things (3 nuclei, 3 tracts) are in the lateral medulla (PICA syndrome)?
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Nuclei: Vestibular, Nucleus Ambiguus, Spinal Trigeminal Tracts: Spinothalamic, Sympathetic, inferior cerebellar peduncle
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What is the PICA syndrome also known as?
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Wallenberg's syndrome
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What are some classic symptoms of PICA syndrome (think of anatomy)?
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Vertigo, Dysphagia, Dysarthria, Hoarseness, Decreased Gag Reflex, Ipsilateral horner's syndrome, Ipsilateral face pain and temp, contralateral body pain and temp, Ipsilateral ataxia
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What 3 syndromes exist in the pons?
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Medial Inferior, Lateral Inferior, and Medial Longitudnal Fasiculus
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How does Medial Inferior Pontine syndrome differ from medial medullary?
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Instead of hypoglossal, you have abducens (root) affected (ipsilateral lateral rectus)
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An occlusion in which arteries can cause medial inferior pontine syndrome
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Paramedian branches of basilar artery
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An occlusion in which artery will cause Lateral Inferior Pontine Syndrome?
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AICA
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What is in the lateral pons (for AICA syndome)?
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Nuclei: Facial nucleus, Cochlear, Vestibular, Spinal Nucleus (trigeminal) Tracts: Sympathetics, Spinothalamic, Cerebellar peduncles,
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What does loss of facial nuclei and fibers cause (Lateral Inferiro pontine syndrome)?
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1. Loss of Motor 2. Taste from ant. 2/3s 3. Parasympathetics to glands 4. Stapedial and Corneal reflexes (efferents)
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What is medial longitudnal Fasiculus syndrome?
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When one of the MLFs in the pons is broken
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What does MLF snydrome cause?
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Intranuclear Opthalmoplegia - medial rectus palsy on attempted lateral gaze towards contralateral side
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What disease is MLF syndrome often seen in?
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Multiple Sclerosis
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What is Weber's Syndrome?
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Medial Midbrain deficits
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What structures are affected in Medial Midbrain Syndrome (weber's)?
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Oculomotor palsy (down and out), Corticospinal, and Corticobulbar (lower face weakness), uvula and pharynx pulled to the normal side
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What is an Acoustic Neuroma?
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Benign tumor of Schawnn cells
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Where do Acoustic neuromas usually happen?
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Internal Auditory Meatus
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What nerves are usually affected by Acoustic Neuromas?
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8 mainly also 7, and maybe 5
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What genetically inherited disorder do you get bilateral acoustic neuromas in?
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Neurofibromatosis type II
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What syndrome can a posterior fossa tumor lead to?
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Jugular Formen Syndrome (9,10, and 11) are affected
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What is Locked in Syndrome?
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Literally you are locked in your own body, only oculomotor and Trochlear nerves work
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What artery occlusion leads to Locked in Syndrome?
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Basilar Artery
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What can central pontine myelinolysis lead to?
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Corticospina and bulbar damage may lead to Locked in Syndrome- Watch rapid correction of hyponatremia
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What are the watershed areas of the brain?
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between ACA and MCA, and between PCA and MCA
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When do watershed areas get damaged?
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When there is global hypotension
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What are watershed area problems known to cause?
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Upper leg and upper arm weakness and defects in higher visual processing
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What can aneurysm ruptures of Anterior Communicating artery lead to?
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Visual field defects
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What does a posterior cerebral artery infarct lead to?
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Contralateral hemianopsia with macular sparing- macula is sent to both
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What do the lateral striate arteries supply?
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Internal capsule, putamen, caudate (basal ganglia) - called arteries of stroke
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Where do berry aneruysms occur?
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Bifurcations of Circle of Willis
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What is them the most common site of berry aneurysm?
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Anterior Communicating Artery
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Does the rupture of an aneurysm in the brain give an intraparenchymal or a subarachnoid hemorrhage?
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Subarachnoid hemorrhage
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What disease states are berry aneurysm associated with?
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ADPCKD, Ehlers Danlos IV, Marfans, AND NF1
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What are the risk factors for berry aneurysms?
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Smoking, Race, age, HTN
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What are small vessel microaneurysms in Basal ganglia/thalamus called and associated with?
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Chronic HTN, and Charcot Bouchard microaeursyms
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What can Charcot-Bouchard microaneurysms lead to?
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Intraparenchyml hemorrhage
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What type of hematoma has a lucid interval?
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Epidural Hematoma
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What type of hematoma results from the rupture of the middle menigeal artery (which derives from foramen spinosum)?
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Epidural Hematoma
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What type of hematoma is common in elderly and is slow developing?
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Subdural Hematoma
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What type of hematoma is related to whiplash?
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Subdural Hematoma
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What type of hematoma is "worst headache of my life" and xanthochromic spinal tap?
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Subarachnoid Hematoma
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An AV malformation yields what type of hemorrhage?
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Subarachnoid Hematoma
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Biconvex disks that do no cross suture lines are what type of hematoma
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Epidural Hematoma
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Crescent shaped disk that cross suture lines are what time of hematoma'
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Subdural Hematoma
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What type of hemorrage is associated with diabetes, amyolid angiopathy, and Charchot Bouchard microaneuryms/
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Intraparenchymal hemorrhage
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What kind of intercranial hemorrhage do you give Ca channel blockers to?
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Subarachnoid Hematoma
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Why do you give Ca channel blockers to subarachnoid hemorrhage/
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To prevent the vasospasm associated with blood in the subarachnoid space
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Where to intraparenchymal hemorrhage in the brain usuall occur?
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Basal Ganglia
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What does blood look like on MRI of brain?
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Bright - M-b-RI-ght
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What does blood look like on CT of brain?
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Dark- CT
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When a large vessel is embolized, what kind of stroke is produced?
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Ischmic
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What types of strokes are due to HTn and involved small vessels?
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Lacunar Strokes
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Whats the treatment of an ischemic stroke?
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Tpa within 3 hours
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Whats the classic triad of sx in normal pressure hydrocephalus?
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Dementia, Ataxia, and urinary incontience (wacky, wobbly, wet)
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What is the status of ventricles in normal pressure hydrocephalus/
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Enlarged
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Whats the most common location for a slipped disk?
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Between L5 and S1
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Where do you lumbar tap?
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Between L3 and L5, keep the Cord alive
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Where does the spinal cord end in adults?
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Between L1 and L2
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How far does the subarachnoid space extend in the spinal cord?
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S2
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What structure helps you to determien where do to a lumbar tap?
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Iliac Crest
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Name the three ligaments punctured in a lumbar tap?
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Supraspinous, Interspinous, and Ligamentum Flavum (Silk Flavor)
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Is the pia pierced during a lumbar tap?
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No, obviously not
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In the corticospinal tract, where are the legs in relation to arms?
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lateral
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In the spinothalamic tract, where are the legs in relation to the arms?
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Lateral
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In the DCML tract, where are the legs in relation to the arms?
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medial
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What is the decussation area called for DCML?
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Internal Arcuate fibers
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Where do spinal reflexes come into play/
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DRG sends info up and over for the reflexes
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How do spinothalamic DRGs send axons into the spinal cord?
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Lissaur's tract (enters at that level)
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Where do spinothalamic tract 2nd order neurons decussate?
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Anterior white comissure at that level, and then ascend contralaterally
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When does Babinski;s sign disappear?
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15 months
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Why does Babinksi;s sign exist?
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The lateral corticospinal tract is not fully myelinated until 2 yrs.
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What layer of primary motor cortex does lateral corticospinal tract begin?
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Layer 5 (internal pyramidal layer) The Giant Cells of Betz
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Where does the lateral corticospinal tract run in the telencephalon?
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Posterior limb of internal capsule
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What is the hypothalamospinal tract?
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Carries sympathetics from posterior nucleus of hypo to the ciliospinal center at T1-T2
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Does the hypothalamospinal tract (symps to ciliospinal center) decussate?
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No, Horners syndrome is always ipsilateral
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What side does the lesion of Horner's syndrome have to be on (ipsi or contralateral)?
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Ipsilateral
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How many classic lesions of the spinal cord are there?
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Eight
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In general, what do upper motor neuron lesions cause?
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Spastic Paresis
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In general, What do lower motor neuron lesions cause?
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Flacid Paralysis
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What are the two lower motor neuron diseases?
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Poliomyelitis and Werndig-Hoffman
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What kind of lesions cause ALS or Lou-Gehrig's disease?
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Upper and lower motor nueron….pyramidal and LMN symptoms
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Do patients with ALS have sensory deficits?
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no
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What genetic defect can cause Lou-Gehrigs or ALS?
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Superoxide Dismutase 1
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What ingested item can cause Lou Gehrigs disease?
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Betel Nut ingestion ( whys he shaking? ) He Super Od'd on Betel Nuts.
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Why is Lou Gehrig shaking on the field?
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He super od'd on betel nuts. (superoxide dismutase 1 deficiency and betel nuts)
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What is Tabes Dorsalis caused by?
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Tertiary Syphillis
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What is the lesion in Tabes Dorsalis?
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Dorsal tables are messed up (dorsal colums)
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What does the histo slide look like in tabes dorsalis?
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Loss of white matter in dorsal colums (very obvious)
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What is the classic clinic exam findings in tabes dorsalis?
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No DTRs, Postive Romberg test, Argyl Robertson pupils, Charcot's joints
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What are Charcot's joints?
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Damaged joints due to loss of pain and position
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What type of pain will a patient with Tabes dorsalis complain of?
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Lightning pain
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Does Tabes Dorsalis cause Ataxia?
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Only when vision is poor (at night)
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What are the 5 signs of Brown-Sequard lesions
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1. Ipsilateral spastic paralysis=below lesion 2. Ipsilateral loss of proprioception/touch below 3. Loss of Contralateral pain and temperature one level below 4. Ipsilateral flacid paraylsis at the level of lesion (ventral horn) 5. If above T1- Ipsilateral Horners
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What is a Brown Sequard leson?
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Half loss of spinal cord
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The artery that caused Medial Medullary syndrome can cause what findings if occluded in spinal cord?
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Loss of everything except dorsal colums and horns
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What can ventral spinal artery occlusion lead to in the spinal cord?
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1. Lateral corticospinals= spastic paraylsis 2. Ventral Horn= Flaccid paralysis at level 3. Hypothalmospinal at T2- Horners Bilateral 4. Spinothalamic both gone
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What area of the spinal cord is most likely to be damaged by spinal artery occlusion'
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Upper Thoracic= watershed. Below T8, Artery of Adamkiewicz
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What 2 diseases cause spinal cord pathology that is a subacute combined degeneration?
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B12 deficiency, Freidreich's Ataxia, and Vitamin E def?
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What is lost in subaacute combined degeneration?
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Spinocerebellar, Lateral Corticospinal tracts (UMN problems) , and DCML pathway
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What is Friedreich's ataxia caused by?
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Autosomal recessive Trinucleuotide Repeat disorder- GAA
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What gene is mutated in Freidreich's ataxia?
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Frataxin
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What does impaired Frataxin do in the cell?
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Impair mitochondria
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What are the foot pathologies of Fredreich's Ataxia?
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Pes Cavus and hammer Toes
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What is the Eventual killer of most Fredreich's Ataxic patients?
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Hypertrophic Cardiomyopathy
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What are the Sx of Fredireichs Ataxia?
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Ataxia, Falling, Nystagmus, Dysarthria "Stumbling, Falling, and Staggering"
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What is Syringomelia?
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Centra Cavitation of the Cervical Cord
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What does Syringomyelia impinge and damage?
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Ventral Comsissure and Ventral Horns
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Since Syringomyelia occurs at a certain level, what muscles of the ventral horns can be damaged?
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Intrinsic muscles of hand (flacid Paralysis)
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What is Syringomelia usually seen with?
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Arnold-Chiari Type II syndrome
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What does loss of anterior comissure of the spinal cord at C8-T1 lead to?
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Loss of Spinothalmaic 2nd order neurons- bilateral loss of pain
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What kind of spinal cord lesions does multiple sclerosis have?
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Random
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What kind of spinal cord lesion do people with polio and werndig hoffman have?
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Lower motor neuron- flaccid paralysis due to destruction of anterior horn
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What type of spinal cord lesion is caused by multiple sclerosis?
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Multiple, random, demylination
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What is Charcots triad for Multiple Sclerosis?
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Scanning speech, Intention tremor, and Nsytagmus Also incontinence and internuclear opthalmoplegia MLF syndrome
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What kind of spinal cord lesions are found in ALS?
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Upper and lower motor neuron signs= most fasiculations
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An occlusion of the anterior spinal artery would spare what tracts in the spinal cord?
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Dorsal colms and lissuers tract
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What is the classic sign for Tabes Dorsalis?
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Locomotor Ataxia
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What does locomotor ataxia look like?
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Walking like a defective robot
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What four signs are associated with B12 deficiency, and Freidreich;s?
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Ataxia (spinocerebellar), Hyperreflexia (lateral cortical), and Dorsal Colum Imparied proprioception and vibration
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What area is most often affected by Multiple Sclerosis?
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White matter of Cervical cord
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By What route is polio tramitted?
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Fecal-Oral
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Where does polio replicate before moving to CNS (2 places)?
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Sore Throat- Oropharynx and Small intestine
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What CSF findings are present in polio?
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Lymphocytes pleocytosis and CSF protein
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What is the difference between Guiallan Barre CSF and polio CSF?
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No pleocytosis in Guilan Barre, but elevated protein
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Where can the polio virus be cultured?
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Stool or Throat only (not in blood) makes sense it doesn’t go there
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Whats the other name for Werndig-Hoffman syndrome?
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Infantile spinal muscluar atrophy
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Whats the inheritance for Werndig Hoffman?
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Auto Recessive
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Which disease has floppy baby and tongue fasciulations?
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Werndig-Hoffman (AR inheritance)
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True or False: Werndig Hoffman is both upper and lower motor neuron involvment.
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False, it is only lower
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Werndig Hoffman is a disease with degeneration of ……Horns.
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Anterior
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Whats the median age of Death in Werndig Hoffman?
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6 months
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True or False. Patients with ALS have sensory, cognitive, and oculomotor deficiency,
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False only motor
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What muscle group is specifically not affected by ALS?
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Oculomotor
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What joint pathology is involved with Tabes Dorsalis?
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Charcots Joint
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True or False, Tabes Dorsalis is increase reflexes.
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False, reflexes are absent
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What test can you use for checking Tabes Dorsalis?
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Romberg Test
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What do children with Freidreich;s Ataxia usually present with in the spine?
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Kyphoscoliosis (http://en.wikipedia.org/wiki/File:Kyphoscoliosis_hereditary_sensory_autonomic_neuropathy_III.jpg)
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What is kyphosis?
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Hunchback
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What is scoliosis?
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Abnromal curvature to the side
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In Brown-Sequard, what kind of motor signs are found ipsilateral below lesion?
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Ipsilateral Upper motor neuron signs (spastic paresis)
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At the level of the lesion, what occurs in Brown Seqaurd?
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Loss of all sensation at the ipsilateral side
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What is the status of pain and temperture sensation at the contralaterla level of the Brown Sequard lesion?
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It is preserved
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What kind of motor deficit is seen at the level of the lesion in Brown-Sequard?
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Ipsilateral lower motor neuron loss -=flacid paralysis
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How can Brown-Sequard create Horners Syndrome?
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If the lesion is above T1
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