Ditt Neuro 1A

Front 1

Label the Circle of Willis

Back 1

see above, also pg 170

Front 2

Label the Circle of Willis, intracranial view

Back 2

see above, also pg 170

Front 3

Magnetic resonance arteriography illustrating the circle of Willis and its branches

Back 3

see labels above

Front 4

What do you see?

Back 4

Lateral common carotid arteriogram in a patient with a neck bruit. Note the focal narrowing of the proximal internal carotid artery (arrow). In severe cases, the kink may require carotid artery reconstruction.

DIT says that you need to be able to recognize a stenosis vs aneurysm

Front 5

What do you see?

Back 5

Left oblique cerebral angiogram in a patient with multiple intracranial aneurysms shows an anterior communicating aneurysm and a middle cerebral artery aneurysm. The patient underwent a frontotemporoparietal craniotomy, during which surgical clips were placed in both lesions in one setting.

DIT says that you need to be able to recognize the difference btw an aneurysm and arterial stenosis on an angiogram

Front 6

what do you see?

Back 6

(from Medscape): Left oblique cerebral angiogram in a patient with a proximal intracranial internal carotid artery aneurysm. The surgical approach to this aneurysm requires a craniotomy with an orbitotomy and drilling of the anterior clinoid process; however, this aneurysm has a favorable neck-to-fundus ratio for endovascular coil placement.

DIT says that you need to be able to recognize the difference btw aneurysm & stenosis on angiogram imaging

Front 7

A 49yo, presents with sudden onset of vertigo, nausea, vomiting, dysphagia, hoarseness, and nystagmus in addition to ipsilateral Horner syndrome, limb ataxia, and impairment of all sensory modalities over the face. There is also impairment of pinprick and temperature appreciation in the contralateral limbs.

Back 7

This case illustrates the development of the lateral medullary syndrome (Wallenberg's syndrome) as a result of occlusion of the posterior inferior cerebellar artery (PICA).

-Loss of pain & temp over contralateral body
-Loss of pain & temp over ipsilateral face
-Cerebellar defects
- Involvement of the sympathetic pathways may lead to Horner's syndrome
- Vertigo results from involvement of the vestibular nuclei and hemiataxia from involvement of the inferior cerebellar peduncle.

Front 8

What viruses preferentially infect the ventral horn of spinal cord, leading to a flaccid paralysis?

Back 8

polio & west nile

Front 9

Which spinal tract carries touch, vibration, and pressure sensation?

Back 9

Dorsal columns:
Fasciculus gracilis & cuneatus

Front 10

Which spinal tract carries voluntary motor commands from motor cortex to body?

Back 10

Lateral & ventral corticospinal tracts

Front 11

Which spinal tract carries voluntary motor commands from motor cortex to head/neck?

Back 11

Corticobulbar tract

Front 12

Which spinal tract carries pain & temp sensation?

Back 12

Lateral spinothalamic tract

Front 13

Which spinal tract is important for postural adjustments & head mvmts?

Back 13

Vestibulospinal tract

Front 14

Which CN is responsible for Eyelid opening?

How do you differentiate between benign & serious cause of deficit of this nerve?

Back 14

CN 3 (oculomoter)

Benign cause (ie HTN or Diabetes) of CNIII palsy - the pupil will be normal in size & reactive - no treatment is needed

Serious causes (ie aneurysm, tumor, or uncal herniation) - pupil will be dilated & nonreactive ("blown") - urgent CT/MRI is needed

Front 15

Which CN is responsible for
Taste from ant 2/3 of tongue?

What other sxs would you look for to distinguish whether the damage to this nerve was UMN or LMN?

Back 15

CN 7 (Facial)

UMN lesion of Facial nerve = forehead is spared on the affected side, cause is usually stroke or tumor

LMN lesion of Facial nerve = forehead is involved, and cause is usually Bell's palsy or tumor

Front 16

Which CN is responsible for
Head turning?

How do you know which side the lesion is located?

Back 16

CN 11 (spinal accessory)

Patients with CN 11 lesions have trouble turning their head to the side OPPOSITE the lesion & have ipsilateral shoulder droop (due to loss of innervation to SCM & trapezius)

Front 17

Which CN is responsible for
Tongue movement?

How do you know which side the lesion is located?

Back 17

CN 12 (hypoglossal)

protruded tongue will deviate to the SAME side of the lesion

Front 18

Which CN is responsible for
Muscles of Mastication?

What pathological condition of this nerve is provoked by chewing?

Back 18

CN 5 (trigeminal) - also innervates facial sensation

Trigeminal Neuralgia ("Tic doulourex") = unilateral shooting pains in the face & often triggered by chewing, brushing the teeth - tx with Carbamazepine

Front 19

Which CN is responsible for balance?

Kids with balance probs - likely cause is?
Adults with balance probs - likely cause?

Back 19

CN 8 (Vestibulocochlear) - needed for hearing & balance

Lesions of CN 8 can cause deafness, tinnitus, and/or vertigo -

in kids, think of meningitis as a cause
in adults - think of medications (aspirin, aminoglycosides, loop diuretics, cisplatin), infection (labyrinthitis, tumor, or stroke

Front 20

Which CN is responsible for monitoring carotid body & sinus chemoreceptors & baroreceptors?

Back 20

CN 9 (glossopharyngeal)

Front 21

What are the 2 most common locations of aneurysms in the Circle of Willis?

Back 21

Anterior communicating artery
Posterior communicating artery

Front 22

Where is the brain lesion if pt presents with:
contralateral hemiballismus

Back 22

subthalamic nucleus

Front 23

Where is the brain lesion if pt presents with:
eyes look toward the side of the lesion

Back 23

frontal eye fields (Prefrontal cortex)

Front 24

Where is the brain lesion if pt presents with:
eyes looking away from the side of the lesion

Back 24

PPRF

Front 25

Where is the brain lesion if pt presents with:
paralysis of upward gaze

Back 25

Superior colliculi (Parinaud syndrome)

Also known as dorsal midbrain syndrome, this is a distinct supranuclear vertical gaze disorder caused by damage to the posterior commissure. It is a classic sign of hydrocephalus from aqueductal stenosis.

Pineal region tumors, cysticercosis, and stroke also cause Parinaud's syndrome.

Features include loss of upgaze (and sometimes downgaze), convergence-retraction nystagmus on attempted upgaze, downward ocular deviation ("setting sun" sign), lid retraction (Collier's sign), skew deviation, pseudoabducens palsy, and light-near dissociation of the pupils.

Front 26

Where is the brain lesion if pt presents with:
hemispatial neglect syndrome

Back 26

non-dominant parietal lobe

Front 27

Where is the brain lesion if pt presents with:
coma

Back 27

reticular activating system (RAS) - in the ventral pons

likely a/w Basilar Artery occlusion

Front 28

Where is the brain lesion if pt presents with:
poor repetition

Back 28

arcuate fasciculus

Front 29

Where is the brain lesion if pt presents with:
poor comprehension

Back 29

Wernicke's area

Front 30

Where is the brain lesion if pt presents with:
poor vocal expression

Back 30

Broca's area

Front 31

Where is the brain lesion if pt presents with:
resting tremor - think of the classic "pill rolling" tremor that disappears with movement or sleep

What conditions cause a resting tremor?

Back 31

basal ganglia (↓ dopamine)- think Parkinson's Disease

Other conditions other than Parkinson's disease that can cause resting tremors:
- hyperthyroidism, anxiety - tx with Beta blockers
- Drug withdrawal or intoxication (MPTP found in designer drugs)
Or Antipsychotics used to treat Schizophrenia - treat this side-effect with anticholinergics (benztropine, trihexyphenidyl) or antihistamines (diphenhydramine)
- benign hereditary tremor - usually Aut Dom (look for fam hx)


Also beware of:
Wilson's disease (hepatolenticular degeneration) - causes chore-like movements
Liver failure - causes asterixis (slow, involuntary flapping of outstretched hands

Front 32

Where is the brain lesion if pt presents with:
intention tremor

Back 32

cerebellar hemisphere

this is why alcoholics will have INTENTION tremors

Front 33

Where is the brain lesion if pt presents with:
hypororality, hypersexuality, disinhibited behavior

Back 33

bilateral amygdala (Kluver-Bucy)

Front 34

Where is the brain lesion if pt presents with:
Personality changes - apathy, inattention, disinhibition, labile affect

Back 34

frontal lobe

Front 35

Where is the brain lesion if pt presents with:
dysarthria (trouble articulating words - slurred speech)

Back 35

cerebellar vermis - this is why alcoholics have slurred speech

Front 36

Where is the brain lesion if pt presents with:
agraphia & acalculia
inability to read, write, name or do math

Back 36

dominant (left) parietal lobe

Front 37

Where do the dorsal columns decussate?

Back 37

medulla

recall the dorsal columns carry touch, vibration, pressure sensation

Front 38

where does the lateral corticospinal tract decussate?

Back 38

medullary pyramids

Front 39

Where does the spinothalamic tract decussate (crossover)?

Back 39

Anterior white commissure at the spinal cord level

spinothalamic carries pain & temperature sensation

correlation: syringomyelia, in which there is central cavitation of the spinal cord (usually in cervical or upper thoracic region) presents with loss of pain & temp sensation in a "cape" distribution b/c damage to the lateral spinothalamic tracts
MRI is best test to diagnose, tx with surgical creation of a shunt

Front 40

fill out this chart - 4star topic!!

what are the common organisms and empiric IV antibiotic choices for bacterial meningitis based on age of the patient?

Back 40

see above

Front 41

What is the rational for dosing dexamethasone prior to or along with the first dose of antibiotics for empiric treatment of bacterial meningitis?

Back 41

Dexamethasone when given with or prior to the first dose of antibiotic reduces the risk of neurologic sequelae (ie hearing loss) in children with meningitis, esp in the cases of H. influenza Type B or Tuberculosis (TB) meningitis
In adults with bacterial mengingitis, dexamethasone reduces both morbidity and mortality esp in the case of pneumococcal meningitis

Front 42

Do you always need to get a CT scan (prior to an LP) if you suspect meningitis?

Back 42

No – you do not have to get a CT scan in a patient you suspect of having meningitis

Front 43

In which situations do you need to get a CT scan prior to an LP?

Back 43

Focal neurologic defects
Papilledema
Pupil asymmetry
Suspect hematoma
Suspect brain tumor