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234 Cards in this Set
- Front
- Back
- 3rd side (hint)
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NE
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Increase anxiety
Decrease depression |
locus ceruleus (stress & panic)
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Dopamine
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Incr schizo
Decr Parkins, depression |
ventral tegmentum and SNc
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5-HT
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decr anxiety and depression
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raphe nucleus
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ACh
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decr Alzheim, Huntington, REM sleep
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basal nucleus of Meynert
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GABA
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decr anxiety, Hunting
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nucleus accumbens (reward center, pleasure, addiction, fear)
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hypothalamus
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TAN HATS
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thirst & water balance
adenohypophysis control neurohypophysis releases hormones hunger autonomics temp sex |
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leptin
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inhibits lateral area (hunger)
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stimulates ventromedial area - satiety
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anterior hypothal
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AC - cooling
parasym |
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posterior hypothal
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heating
symp |
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suprachiasmatic nucleus
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circadian rhythms
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ADH
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made in supraoptic
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oxytocin
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made in paraventricular
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thalamus
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major relay for ascending sensory info
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VPL
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spinothal and dorsal columns and medial lemniscus
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pain and temp, position and proprioception. going to primary somatosensory cortex
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VPM
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trigem and gustatory pathway (Make up on face)
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primary somatosens cortex
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LGN
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CNII
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calcarine sulcus
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MGN
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sup olive and inf colliculus of pons (hearing)
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auditory cortex of temporal lobe
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Limbic system
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cingulate gyrus
hippocampus fornix mammillary bodies septal nucleus |
Feeding
Fleeing Fighting Feeling Fucking |
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cerebellum
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contralateral cortical input from middle cerebellar peduncle and ipsilateral proprioceptive info via inf cereb ped. input nerves are climbing and mossy fibers
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stim feedback to contralateral cortex, out put nerves are Purkinje fibers to deep buclei of cerebellum to cortex via sup cereb ped
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deep nuclei (L-->M)
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Dentate, Emboliform, Globose, Fastigial
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Lateral cerebellum
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voluntary mvmt of extremeties
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medial cerebellum
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balance, truncal coord, ataxia, fall to injured side
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basal ganglia
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vountary mvmt and posture. receives cortical input, provides neg fb back to cortex
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striatum
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putamen + caudate
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lentiform
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putamen + globus pallidus
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DI-R
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D1 receptor is direct (stim)
D2 is indirect, inhib |
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Direct path
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cortex and D from substantia nigra pars compacta stim D1 R in striatum. ACh stims GABA, substance P, which inhibit globus pallidus internus and sunstantia nigra pars reticulata, which inhibits thalamus and stims cortex
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increases motion. loss of dopamine results in decreased motion
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Indirect path
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cortex stims striatum but D from SNc inhibits via D2, leads to Ach which inhibits GABA and enkephalin, which inhibits GPe, which inhibits subthalamic nucleus, which stims GPi, which inhibits thal which stims cortex
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normally, inhibiting inhibitory pathway leads to more motion so loss of dopamine leads to inhibition and less motion
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hemiballismus
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contralateral subthalamic nucleus lesion. loss of inhibition of thalamus through globus pallidus
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Huntingtons
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neuronal death via NMDA-R binding and glutamate toxicity. atrophy of striatal nuclei (main inhibitors of mvmt)
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CAG repeats. Caudate loses ACh and GABA.
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Chorea
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basal ganglia lesion
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athetosis
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slow writhing mvmt
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basal ganglia lesion
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dystonia
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sustained involuntary muscle contractions
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writers cramp
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essential tremor
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action tremor (worse when holding posture). AD
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self-med with etoh, which decreases tremor. tx: b blockers
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resting tremor
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parkinsons
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distal
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intention tremor
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zigzap when pointing
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cerebellar dysfxn
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amygdala
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kluver-bucy syndrome
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hyperorality, hypersex, disinhib behavior
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frontal lobe
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disinhib, poor conc, orientation, judgment. primitive reflexes
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right parietal lobe
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spatial negleclt syndrome (agnosia of contralateral side of world)
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reticular activating system (midbrain)
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reduced arousal/wakefulness
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mammillary bodies
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wenicke-korsakoff
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confusion, ophthalmiplegia, ataxia
memory loss, confabulation, personality change |
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cerebellar hemisphere
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intention tremor, limb ataxia
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cerebellar vermis
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truncal ataxia, dysarthria
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STN
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contralateral hemiballismus
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hippocampus
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anterograde amnesia (no new memories)
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paramedian pontine reticular formation
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eyes look away from side of lesion
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frontal eye fields
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eyes look toward lesion
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central pontine myelinolysis
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acute paralysis, dysarthria, dysphagia, diplopia, LOC. from hyponatremia correction. increased signal in pons.
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recurrent laryngeal nerve
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lose all larynx muscles except cricothyroid
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dysarthria
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motor inability to speak
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brocas
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broken boca
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nonfluent aphasia with intact comprehension
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wenickes
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wordy
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fluent aphasia with impaired comprehension
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conduction
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poor repetition but fluent speech, intact comprehension.
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arcuate fasciculus
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PCA
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contralateral hemianopia with macular sparing
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MCA
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contralateral face and arm paralysis and sensory loss, aphasia, left-side neglect
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ACA
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leg-foot area of motor and sensory cortices
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Ant Comm Art
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most common circle of willis aneurysm
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visual field defects
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Post comm art
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CNIII palsy
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lateral striate
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divisions of middle cerebral artery, supply internal capsule, caudate, putamen, GP.
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infarct of post GP causes pure motor hemiparesis
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watershed zones
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between ACA/MCA, PCA/MCA
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damage in severe hypotension. upper leg and upper arm weakness, higher order visual processing problems
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anterior circle stroke
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sensory and motor dysfunction, aphasia
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posterior circle stroke
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cranial nerve deficits, coma, cerebellar defects, dominant hemisphere ataxia, nondominant neglect
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anterior spinal
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contralat hemiparesis of lower extrem, medial lemniscus (less contralat proprioception), ipsilateral paralysis of hypoglassal
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PICA
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contralat loss pain/temp, ipsi dysphagia, hoarseness, decr gag reflex, vertigo, diplopia, nystagmus, vomit, ipsi horners, ipsi face pain/temp, trigem, ipsi ataxia
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AICA
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ipsi face para, ipsi coch, vestib (nystagmus), ipsi face pain/temp, ipsi dystaxia
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aneurysms
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APCKD, Ehlers-Danlos, Marfans
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Charcot-Bouchard microaneurysms
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chronic HTN, basal ganglia and thalamus affected
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epidural hematoma
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rupture of middle meningeal artery (branch of maxillary), often fractured temporal bone. lucid interval, then transtentorial herniation and CNIII palsy
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biconcave disk not going thru suture lines. can cross falx, tentorium
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subdural hematoma
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rupture of bridging veins. delayed symptoms. elderly, alcoholics, blunt trauma, shaken baby
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crescent shape, crosses suture lines. gyri preserved, cannot cross falx, tentorium
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subarachnoid hemorrhage
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aneurysm or AVM ruptures. worst HA. bloody or yellow spinal tap.
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2-3 days later, vasospasm. tx with CCB
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parenchymal hematoma
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causes: HTN, amyloid angiopathy (lobar strokes), DM, tumor.
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basal ganglia and internal capsule
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ischemic brain dz
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irreversible damage after 5 mins
most vulnerable: hippo, cerebell, watershed, neocortex. red neurons (12-48 hrs), necrosis and neutros (24-72hrs), macrophages (3-5 days), reactive gliosis and vasc prolif (1-2 wks), glial scar (2 wks) |
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stroke imaging
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bright on diffusion-weighted MRI in 3-30 mins, stays bright 10d
dark on noncontrast CT, bright is hemorrhage |
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sup sagittal sinus
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main area of CSF return via arachnoid gran
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normal pressure hydrocephalus
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wet, wobby, and wacky
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communicating hydrocephalus
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decr CSF absorption
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hydrocephalus ex vacuo
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incr CSF in atrophy. no ICP (Alz, Picks, HIV)
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lumbar puncture
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L3-5
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dorsal columns
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pressure, vibration, touch, proprioception
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fasciculus cuneatus (upper body, extremities) is lateral
fasciculus gracilis (lowe body, extremities) is medial |
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spinothalamic tract
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ventral
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pain and temp
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lateral corticospinal tract
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voluntary motor
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legs are lateral
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upper motor neuron
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everything up
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tone DTRs, toes
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LMN
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atrophy and fasciculation
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poliomyelitis and wednig-hoffmann
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LMN, destroy anterior horns. flaccid paralysis
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anterior spinal artery occlusion
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spares dorsal columns
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tabes dorsalis
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affects dorsal columns
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impaired proprioception and locomotor ataxia
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MS
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random. scanning speech, intention tremor, nystagmus
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ALS
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combined UMN and LMN, no sensory def
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syringomyelia
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damages anterior white commissure of spinothalamic tract, resulting in bilateral loss of pain/temp. arnold-chiari II
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Vit B12, Vit E defs and Friedreich's ataxia
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demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
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ataxic gait, hyperreflexia, impaired position and vibration sense
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polio sx
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malaise, HA, fever, nausea, abd pain, sore throad, muscle weak, atrophy, fasciculations, fibrillation, hyporeflexia
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CSF with lymphocytic pleocytosis with slight elevation of protein (no change in glucose). virus in stool/throat
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Werdnig-Hoffmann dz sx
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infantile spinal muscular atrophy. AR. floppy baby. tongue fasciculations. die at 7mos
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degen of anterior horns, LMN
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ALS
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defect in SOD1, betel nut ingestion. fasciculations
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tabes dorsalis sx
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charcot's joints, shooting pain, argyll robertson pupils, absence of DTRs, positive romberg, sensory ataxia at night
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Friedreich's ataxia
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AR trinucleotide repeat (GAA, frataxin gene)
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impaired mitochondria, staggering gait, freq falls, nystagmus, dysrthria, pes cavus, hammer toes, HCM (cause of death). kids have kyphoscoliosis
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brown sequard
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hemisection of spinal cord
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ipsi UMN signs below, ipsi loss of tactile/vibration/proprioception (dorsal) below, contra pain/temp loss below, ipsi sensation loss at lesion level, LMN signs at level
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horners
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PAM is Horny
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ptosis, anhidrosis, miosis (pupil constrict)
spinal cord lesion about T1 |
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muscle spindles
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monitor muscle length
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help you pick up heavier suitcase than you thought
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Golgi Tendon
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monitor muscle tension
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let go of a heavy object when it's too heavy
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superior collilculi
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vision
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inferior collilculi
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hearing
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parinaud syndrome
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paralysis of conjugate vertical gaze due to lesion in superior collilculi (pinealoma)
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oculomotor
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pupil constrict (PS, E-W nuc, musc), accommodation, eyelid open (levator palp)
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trigem
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mastication, ophthalmic, maxillary, mandibular divisions
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facial
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taste fron anterior 2/3 tongue, lacrimation, salivation (submand, subling), eyelid closing (orbic), stapedius
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glossopharyngeal
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taste from post 1/3 tongue, swallow, salivate (parotid), chemo/baro, sytlopharyngeus (elevate pharynx, larynx)
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vagus
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epiglottic taste, swallow, palate elevation, midline uvula, talk, cough, viscera, chemo/baro
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nucleus solitarius
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visceral sensory info (taste, baroreceptors, gut distention)
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VII, IX, X
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nucleus aMbiguous
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motor innervation of pharynx, larynx, upper esophagus
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IX, X, XI
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dorsal motor nucleus
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PS fibers to heart, lungs, upper GI
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CNXII lesion
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LMN lick your wounds
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CNV motor lesion
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jaw deviates toward side of lesion
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CNX lesion
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uvula deviates away from side of lesion
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CNXI lesion
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weakness turning head to contralateral side of lesion, shoulder droop on side of lesion
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UMN facial lesion
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contralateral paralysis of lower face only
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LMN facial lesion
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ipsilateral paralysis of upper and lower face
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Bells palsy
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AIDS, Lyme, Herpes, Sarcoid, Tumors, DM
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KaLaMity test
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X, XII, VII
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lateral ptergoid
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opens jaw. V3.
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takes more muscles to keep your mouth shut
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masseter, teMporalis, Medial pterygoid
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close jaw
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CN X innervates all palat muscles except
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tensor veli palatini (CNV)
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CNXII innervates all glossus muscles except
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palatoglossus (X)
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perilymph
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Na+ rich, sim to ECF
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endolymph
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K+ rich
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utricle and saccule
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contain maculae, detect linear acceleration
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semicircular canals
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contain ampullae, detect angular acceleration
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near vision
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ciliary muscle contracts, zonular fibers relax, lens relaxes and becomes more convex
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distant vision
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ciliary muscle relaxes and lens flattens
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ciliary muscle
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M3 accommodation
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ciliary process
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beta produces aqueous humor
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sphincter muscle of iris
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M3, miosis
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dilator/radial muscle of iris
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a1, mydriasis
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glaucoma
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cupping
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closed angle glaucoma
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no epi
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CNIII damage
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look down and out, ptosis, pupillary dilation, loss of accommodation
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CNIV damage
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diplopia, downward gaze, tilts head toward lesion
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CNVI damage
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medially directed eye
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marcus gunn pupil
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afferent pupilary defect. decreased bilateral pupillary contraction with light shine
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pretectal nuclei
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pupillary light reflex
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MLF damage
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MS. nystagmus in abducting eye
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vestibular
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COWS
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cold water, nystagmus toward lesion with quick phase to opposite side
warm water: nystagmus to opposite side with quick phase to same side |
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Alzheimers
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down syndrome
ApoE2 protective. apoE4 late onset. |
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Picks (frontotemporal lobe)
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aphasia, parkinson, personality change
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pick bodies are tau
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CJD
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rapid, monoclonus
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spongiform cortex
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MS findings
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incr IgG in CSF, oligoclonal bands are dx. MRI. periventricular plaques with axon preservation
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Guillain Barre
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inflamm and demyelination of peripheral nerves and motor fibers of ventral roots. symmetric ascending muscle weakness. sometimes autonomic dysreg.
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incr CSF protein with normal cell count. papilledema.
tx: plasmapheresis, IVIG |
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PML
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demyelin of CNS due to destroyed oligos. JC virus. fatal.
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acute disseminated encephalomyelitis
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multifocal perivenular inflamm and demyelin after ifxn or vacc
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metachromatic leukodystrophy
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AR LSD due to arylsulfatase A def. sulfatide buildup impairs myelin sheath
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Charcot-Marie-Tooth dz
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hereditary motor and sensory neuropathy. peripheral myelination defects.
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simple partial seizure
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consciousness intact
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complex partial seizure
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impaired consciousness
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generalized seizure - absent
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petit mal, no postictal confusion. blank stare
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generalized seizures - myoclonic
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quick repetitive jerks
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tonic clonic (gen)
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grand mal. alternating stiffening and movement
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tonic (gen)
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stiffening
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atonic
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drop seizures. falls to floor. looks like a faint.
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migraine
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due to irritation of CN V and release of substance P, CGRP, vasoactive peptides.
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tx: propanolol, NSAIDs, sumatriptan acute
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peripheral vertigo
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semicircular canal debris, vestibular nerve ifxn, menieres dz
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positional testing: delayed horizontal nystagmus
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central vertigo
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less common. brain stem or cerebellar lesion. vestibular nuclei, posterior fossa tumor
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positional testing shows immediate nystagmus in any direction
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sturge weber
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congenital disorder with port-wine stains around V1, ipsilateral angiomas, pheos
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glaucoma, seizures, hemiparesis, MR.
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Tub sclerosis
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hamartomas, MR, seizures, ash leaf spots, AD
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neurofibromatsis I
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cafe au lait, lisch nodules (hamartomas), skin, optic gliomas, pheos, AD. NF-1 on Ch17
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von hippel lindau
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cavernous hemangiomas, bilat RCC, retina, brain stem, cerebellum, pheo, AD, VHL Ch3
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supratentorial tumors
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adults (infra are kids)
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half adults are mets
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glioblastoma multiforme (grade IV astrocytoma)
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most common adult, bad prog. astrocytes have GFAP. in cerebrum, can cross corpus.
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psuedopalisading pleomorphic tumor cells border central area of necrosis and hemorrhage
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meningioma
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2nd most common adult. parasag. from arachnoid cells. surg.
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spindle cells concentrically arranged in whorled pattern psammomas
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schwannoma
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3rd most common adult. acoustic often. surg. S-100. cerebellopontine angle
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NF2 if bilateral
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oligodendroglioma
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rare, slow. frontal. chicken-wire capillary pattern
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fried egg cells. calcified
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pituitary adenoma
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rathkes pouch
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pilocytic astrocytoma
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well circ. kids. posterior fossa. GFAP. benign
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rosenthal fibers - eosinohilic, corkscrew fibers.
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medulloblastoma
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malig. PNET. hydroceph. kids
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rosettes or perivasc pseudoros. small blue cells. radiosens.
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ependymoma
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4th vent. hydroceph. bad prog. kids
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perivasc pseudoros. rod shaped blepharoplasts (basal ciliary bodies) near nucleus
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hemangioblastoma
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kids. cerebellar. VHL if retinal too. makes epo.
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foamy cells and high vasc.
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craniopharyngioma
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kids. benign. supratent.
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rathke. calcification
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uncal herniation
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stretches CNIII (ipsi dilated pupil, ptosis)
compresses ipsi PCA (contra hommonymous hemianopia) compresses contra crus cerebri (ipsi paresis) caudal displace brain stem (duret hemorrhage) |
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ring enhancing lesion
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mats, abscess, toxo, AIDS lymphoma
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uniformly enhancing lesion
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lymphoma, meningioma, mets
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heterogeneously enhancing lesion
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Glioblastoma multiforme
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alpha agonist glaucoma
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epinephrine and brimonidine
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decr aqueous humor synthesis
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glaucoma beta blockers
|
timolol, betaxolol, carteolol
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dec aqueous humor secretion
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glaucoma diuretics
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acetazolamide
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decr aqueous humor secretion
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glaucoma cholinomimetics
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pilocarpine, carbachol, pyhysostigmine, echothiophate
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incr outflow, contract ciliary muscle to open trabecular meshwork
sfx: miosis, cyclospasm |
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glaucoma prostaglandin
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latanoprost
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incr outflow. darkens iris
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opioids
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open K+ channels, closeCa, decr synaptic transmission. inhibit release of ACh, NE, 5-HT, glutamate, substance P.
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butorphanol
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partial agonist at mu, agonist at kappa
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causes withdrawl if on full opioid agonist
|
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tramadol
|
weak opioid agonist, inhibits serotonin and NE reuptake
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partial seizure drugs
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phenytoin, carbamazepine, lamotrigine, gabapentin, topiramate, phenobarbital, valproic acid, tiagabine, vigabatrin, levetiracetam
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tonic clonic seizure drug
|
1) phenytoin, carbamazepine, valproic acid
2) lamotrigine, gabapentin, topiramate, phenobarbital, levetiracetam |
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absence seizure drug
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1) ethosuximide
2) valproic acid |
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status epilipticus durgs
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1) phenytoin for prophylaxis
2) diazepam/lorazepam acute |
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incr Na+ channel inactivation
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phenytoin, carbamazepine (trigem neuralgia!), lamotrigine (sorta)
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gabapentin
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GABA analog, inhibits HVA Ca channels
for periph neuropathy, bipolar |
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topiramate
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blocks Na channels, incr GABA
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phenobarbital
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incr GABA-A
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pregnant women and kids
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valproic acid
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incr Na inactiv, incr GABA
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also for myoclonic seizures
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ethosuximide
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blocks thalamic T type Ca channels
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Benzos
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increase GABA A
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also for ecclampsia (after Mg)
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tiagabine
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inhibits GABA reuptake
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vigabatrin
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irreversibly inhibits GABA transaminase, incr GABA
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levetiracetam
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modulates GABA and glutamate release
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carbamazepine tox
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diplopia, ataxia, agran, aplastic anemia, liver, teratogen, induce p450, SIADH, stevens-johnson
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ethosuximide tox
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GI, HA, hives, stevens-johnson
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phenobarbital tox
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p450 induction
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phenytoin tox
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nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogen, SLE-like, induce p450
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valproic acid tox
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GI, liver, spina bifida, tremor, WG
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lamotrigine tox
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stevens johnson
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gabapentin tox
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sedation, ataxia
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topiramate tox
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mental dulling, sedation, kidney stones, WL
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barbituates
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thiopental. incr duration of Cl channel opening, thus facilitate GABA and decr neuron firing
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benzos
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facilitate GABA by incr freq of Cl channel opening. decr REM
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short acting benzos
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TOM. triazolam, oxazepam, midazolam. highest addictive potential
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non benzo hynptics
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zolpidem, zaleplon, eszopiclone
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insomnia. reverse with flimaxenil. tox: ataxia, HA, confusion
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anesthetics
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lipid soluble or active tpt. decr blood solubility means rapid induction and recovery. incr lipid solubility means incr potency.
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inhaled anesthetics
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hepatotox (halothane), nephrotox (methoxy), proconvulsant (enflurane), malignant hyperthermia, expansion of trapped gas (NO)
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intravenous anesthetics - barbituates
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thiopental high potency, high lipid solub, rapid brain entry. induction of anesthesia, short procedures.
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intravenous anesthetics - benzos
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midazolam for endo. amnesia
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intravenous anesthetics - arylcyclohexylamines
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ketamine. PCP analog. block NMDA. stimulant. disorient, hallucinate, bad dreams
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intravenous anesthetics - opiates
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morphine, fentanyl
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propofol
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rapid induction, short procedures. potentiates GABA
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local anesthetics, esters
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procaine, cocaine, tetracaine
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local anesthetics, amides
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lidocaine, mepivacaine, bupivacaine
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block activated Na channels
block small, myelinated nerves first, but size predominatse. lose pain first, then temp, touch, pressure given with vasoconstrictors (except cocaine) |
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neuromuscular blocking drugs, depolarizing
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succinylcholine
in phase I, block potentiated if try to reverse with cholinesterase inhibitors (prolonged depol); in phase II (repolarized), they work (ie neostigmine) |
complications: hypercalcemia, hyperkalemia
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neuromuscular blocking drugs, non-depolarizing
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tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
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compete with ACh at receptors. reverse with neostigmine, edrophonium, cholinesterase inhibitors
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dantrolene
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tx neuroleptic malignant syndrome
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prevents release of Ca from sarc retic
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BALSA
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bromocriptine, amantadine, levodopa, selegiline, antimuscarinics
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parkinsons drugs
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park your mercedes benz
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benztropine. antimuscarinic, improves tremor and rigidity but not bradykinesia
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parkinsons
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agonize D receptos
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bromocriptine, pramipexole, ropinirole (non-ergot)
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incr dopamine
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anantadine (tox ataxia), L-dopa/carbidopa.
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L=dopa can cross BBB and is converted there to dopamine.
tox: arrhythmias, dyskinesia after admin, akinesia betw. carbidopa is peripheral decarboxylase inhibitor. |
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prevent dopamine breakdown
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selegiline (selective MAO type B inhib), entacapone, tolcapone (COMT inhibs, prevent L-dopa degrad)
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selegiline inhibits MAO-B, which metabolizes D over NE and 5-HT
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memantine
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NMDA receptor antagonist, helps prevent excitotoxicity (from Ca)
Alz. |
tox: dizzy, confused, hallucinate
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donepezil, galatamine, rivastigmine
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AChE inhibitors. Alz
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nausea, dizzy, insomnia
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Huntingtons MOA, drugs
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incr dopa, decr GABA and ACh
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Reserpine and tetrabenazine - amine depleting
haloperidol - dopamine receptor antagonist |
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sumatriptan
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5-HT 1B/1D agonist. vasoconstricts, inhibits trigem activation and vasoactive peptide release
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tox coronary vasospasm, mild tingle
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