Neuroscience Guest Lecturers Material

Front 1

Irreversible damage to cells happens at

Back 1

bloodflow below 10cc/min (100g/min)

Front 2

Wallenberg Syndrome signs

Back 2

1) Ipsilateral Horner's, facial numbness, vagus nerve dysfunction, numbness of arm, trunk, or leg
2) Contralateral impaired Pain/Temp on half of body

Front 3

Wallenberg Syndrome artery occluded

Back 3

PICA (not PCA)

Front 4

PICA occlusion symptoms & name

Back 4

Wallenberg Syndrome
1) Ipsilateral Horner's, facial numbness, vagus nerve dysfunction, numbness of arm, trunk, or leg
2) Contralateral impaired Pain/Temp on half of body

Front 5

No significant improvement in surgery vs leaving alone in what problem?

Back 5

Hypertensive hemorrhage

Front 6

What is an AVM?
What is the most common presentation?

Back 6

AVM = Arterial Vascular Malformation
(abnormal communication btwn artery & veins)
#1 presentation: Cerebral Hemorrhage

Front 7

What to do w/ an LP if see blood in CSF?

Back 7

test for xanthochromia to make sure LP was not traumatic
(truly bad = xanthochromia, traumatic LP (poorly performed) = no xanthochromia)

Front 8

Decorticate rigidity

Back 8

rubrospinal tract uninhibited (c/o lesion at PLIC or above)
Upper limb flexed, lower limb extended

Front 9

Decerebrate rigidity

Back 9

cut between vestibulospinal & rubrospinal tract
upper limb extended (c/o rubrospinal cut off)
lower limb extended (c/o vestibulospinal intact)

Front 10

Decorticate to decerebrate rigidity

Back 10

negative sign (lesion moving down from PLIC to between red & vestibulospinal)

Front 11

Corticospinal function

Back 11

crossed fine distal limb flexion

Front 12

corticobulbar function

Back 12

uncrossed facial movement

Front 13

Corticorubral function

Back 13

crossed distal flexion

Front 14

Corticoreticular function

Back 14

uncrossed trunk & proximal limb extension

Front 15

Vestibulospinal function

Back 15

uncrossed trunk & proximal limb function

Front 16

Most common CN neuropathy from trauma

Back 16

CN I lesion c/o cribiform plate shearing off -> anosmia

Front 17

Cranial nerve IX

Back 17

Gag, taste, carotid body, stylopharyngeus
Lesion -> Palate goes away from lesion

Front 18

Cranial Nerve X

Back 18

Swallow, talk, sensation, viscera -> uvula goes away from lesion

Front 19

CN III vs CN VII

Back 19

CN III: keeps eye open
CN VII: Closes eye

Front 20

Ankle Jerk reflex tests what

Back 20

S1

Front 21

Most common entrapment neuropathy
how to test?

Back 21

Median nerve (passes under transverse carpal ligament through carpal tunnel)
test grip

Front 22

Most common cause of Peripheral neuropathy

Back 22

DM (diabetes mellitus)

Front 23

Most important tool for diagnosing acquired neuropathy

Back 23

A good history!

Front 24

Median nerve supplies?

Back 24

LOAF muscles
"Meat LOAF"
Lumbricles 1 & 2
Opponens Pollicis
Abductor pollicis brevis
Flexor Pollicis Brevis

Front 25

Initial treatment of head injury

Back 25

Airway
Breathing
Circulation
Deformity
Environment

Front 26

Glasgow Coma Scale:

Back 26

MVE (Motor, Verbal, Eyes - "Motor Vehicle Eccident")
M 1-6
V 1-5
E 1-4
MUST PERFORM AFTER RECOVERY (otherwise means nothing)

Front 27

Doubling of mortality & morbidity in Head injury

Back 27

Single episode of hypotension or hypoxia
Hypotension = <90 (in males)

Front 28

Severe Head injury on GCS

Back 28

3 to 8

Front 29

Epidural hematoma
Shape on CT/MRI
Cause

Back 29

lens shape
Arterial (usually Middle meningial a)

Front 30

Subdural hematoma
shape
cause

Back 30

More Crescent shaped (bridging veins)
venous cause

Front 31

Diffuse axonal injury
Shape on CT/MRI
Cause

Back 31

Gray & white matter densities separated, usually midline

Front 32

Where does most of head injury occur?

Back 32

After getting into the medical system (secondary injury)

Front 33

Most common thing seen in head injury

Back 33

Edema - may block all ventricles

Front 34

Ischemia limit
effects of

Back 34

pO2 <20mmHg -> anaerobic resp
lactate buildup -> low pH
Mitochondrial dmg (pH 6.0-6.4 inhibits mitochondrial respiration)
no mitochondria -> no Ca+ sequestering (no active transport w/o)

Front 35

Edema types

Back 35

Vasogenic
Cytotoxic (increased H+ c/o low pH -> cells swelling, trying to dilute)
Hydrocephalic
Interstitial)

Front 36

Most localizing part of neuro exam in spinal cord patients

Back 36

pin prick exam

Front 37

Brown Sequard Syndrome What is it?

Back 37

Hemisection of spinal cord (usually penetrating objects)

Front 38

Brown Sequard Syndrome symptoms

Back 38

1) Ipsilateral loss of motor below lesion
2) Contralateral loss of Pain/Temp
3) Ipsilateral loss of light touch, proprioception, vibration

Front 39

Most promising incomplete spinal cord injury in terms of recovery

Back 39

Brown Sequard Syndrome (90% regain independent ambulation, anal, urinary sphincter control)

Front 40

Cranial perfusion pressure calculation

Back 40

CPP = MAP - ICP
MAP = Mean arterial pressure
ICP = Intracranial pressure

Front 41

Most important secondary factor affecting head injury outcome

Back 41

cerebral ischemia

Front 42

Role of mannitol in brain injury

Back 42

Vasoconstricts, decreases edema (pulls water through BBB)
works best at high ICP, low CPP (at vasodilation)

Front 43

Role of glucose in brain injury

Back 43

do not give
aggravates ischemic insults & increases lactic acidosis
worse outcome

Front 44

Seizures after head injury and epilepsy definitions

Back 44

Immediate: within hours
Early: w/in 7 days
Late: after 7 days
Epilepsy: 2-3 unprovoked seizures in the late period

Front 45

Definition of Epilepsy:

Back 45

2-3 unprovoked seizures in the late perioed (after 7 days)

Front 46

Hypothermia role in Brain injury

Back 46

good in 4-6 hours (get down to 32C) but not after
if wait get lactic acidosis

Front 47

Cremasteric reflex tests nerves

Back 47

L1, L2

Front 48

Bulbocavernosus reflex tests nerves

Back 48

S2,3,4

Front 49

Bulbocavernosus reflex use

Back 49

1st reflex to come back
MUST be present for diagnosis

Front 50

Three major categories of Spinal cord injury are:

Back 50

1) Young pt involved in MVA
2) Elderly w/ spinal cord stenosis
3) GSW's to the spine

Front 51

Goal of initial resuscitation for spinal cord injury:

Back 51

restore perfusion pressure of at least 60mmHg

Front 52

Central cord Syndrome

Back 52

often from cervical spinal stenosis or other narrowing, accidents/falls/neck extension
MOTOR LOSS IS GREATER IN UPPER EXTREMITIES than lower
involves central gray and surrounding white (more involved in UE function)

Front 53

Anterior Cord Syndrome (aka Anterior Spinal Artery Syndrome)
affects what part of cord
causes of
signs/symptoms

Back 53

Anterior 2/3 of cord affected
flexion/compression mechanism, diving accidents, ichemia of ASA
Lose all motor & pain/temp below lesion & perserve posterior column sensation
bowel bladder affected

Front 54

Posterior Cord syndrome signs/symptoms

Back 54

Peserve motor & pain/temp w/ loss of posterior column function (proprioception, two point tactile, vibration)
can walk but need visual input for spatial orientation

Front 55

Conus Medullaris Syndrome signs/symptoms

Back 55

Loss of bladder/bowel control
loss of perirectal sensation & poor rectal tone (bilateral)
Saddle anaesthesia
No motor signs in legs (ankle jerk S1 is gone)
Poor prognosis for return of bladder/bowel

Front 56

Methylprednisone (& other steroids) use in ASCI (acute spinal cord injury)

Back 56

Data does not support use
Increase in complications in 25 hr & 48 hr length
(Neurosurgery 2002 Mar)