Neuro 2 - Brain Tumors, Sleep, Strokes+Vascular Events

gsafsaf's version from 2015-05-22 17:58

Brain tumors

Question Answer
Most common adult brain tumorGlioblastoma multiforme
1 year median survivalGlioblastoma multiforme
Cerebral hemispheres; can cross corpus callosumGlioblastoma multiforme
Stain astrocytes for GFAPGlioblastoma multiforme
Pseudopalisading pleomorphic tumor cells Glioblastoma multiforme
AstrocytomaGlioblastoma multiforme
2nd most common adult brain tumorMeningioma
Typically benignMeningioma
Often occurs in convexities of hemispheresMeningioma
Arises from arachnoid cellsMeningioma
External to brain parenchymaMeningioma
Often asymptomaticMeningioma
Psammoma bodiesMeningioma
Usually cerebellarHemangioblastoma
Assctd w von Hippel-Landau syndrome when found w retinal angiomas Hemangioblastoma
Can produce erythropoieten -> polycythemiaHemangioblastoma
3rd most common adult brain tumorSchwannoma
Assctd w NF-2 when bilateralSchwannoma
Classically at cerebellopontine angleSchwannoma
"Fried egg" cellsOligodendroglioma
Relatively rareOligodendroglioma
Most often in frontal lobesOligodendroglioma
Bitemporal hemianopiaPituitary adenoma
Hyper or Hypo-pituitarism Pituitary adenoma
Most common child brain tumorPilocytic astrocytoma
Well circumscribedPilocytic astrocytoma
Often in posteror fossa - may be supratentorialPilocytic astrocytoma
Stain astrocytes for GFAPPilocytic astrocytoma
Rosenthal fibers (eosiniphillic corkscrews)Pilocytic astrocytoma
Benign, good prognosisPilocytic astrocytoma
Highly malignant cerebellar tumorMedulloblastoma
2nd most common child brain tumorMedulloblastoma
Can most compress 4th ventricle -> hydrocephalusMedulloblastoma
Can send metastases to spinal cordMedulloblastoma
Homer-Wright RosettesMedulloblastoma
3rd Most common child brain tumorEpendymoma
Most commonly within the 4th ventricle -> hydrocephalusEpendymoma
Perivascular rosettesEpendymoma
Benign childhood tumorCraniopharyngioma
Derived from remnants of Rathke pouchCraniopharyngioma
Supratentorial child brain tumorCraniopharyngioma
Child brain tumorsInfratentorial
Adult brain tumorsSupratentorial


Question Answer
Awake EEG waveformBeta (highest frequency, lowest amplitude)
Relaxed, eyes closed EEG waveformAlpha
Stage N1 non-REM sleep EEG waveformTheta
Stage N2 non-REM sleep EEG waveformSleep spindles and K complexes
Stage N3 non-REM sleep EEG waveformDelta (lowest frequency, highest amplitude)
REM sleep EEG waveformBeta (highest frequency, lowest amplitude)
Stage N1Light sleep
Stage N2Deeper sleep
Stage N2Bruxism
Stage N3Deepest non-REM sleep
Stage N3Sleepwalking
Stage N3Night terrors
Stage N3Bedwetting
Imipramine (TCA)Can shorten N3 sleep
REM Dreaming
REMLoss of motor tone
REMIncreased brain O2 use
ElderlyIncreased REM latency
DepressionDecreased REM latency

CNS arteries

Question Answer
Blood supply to medial portions of the cortex down deep in the longitudinal fissure along corpus callosumAnterior Cerebral Artery
Leg region of Sensory homunculusAnterior Cerebral Artery
Foot region of Sensory homunculusAnterior Cerebral Artery
Leg region of Motor homunculusAnterior Cerebral Artery
Foot region of Motor homunculusAnterior Cerebral Artery
Blood supply to the lateral aspect of the primary motor and sensory cortexMiddle Cerebral Artery
Bloody supply to Broca's AreaMiddle Cerebral Artery
Face region of Sensory homunculusMiddle Cerebral Artery
Hand region of Sensory homunculusMiddle Cerebral Artery
Face region of Motor homunculusMiddle Cerebral Artery
Hand region of Motor homunculusMiddle Cerebral Artery
Blood supply to occipital lobe - visual cortexPosterior Cerebral Artery

Strokes/Cortical lesions

Question Answer
Expressive AphasiaBroca's Aphasia
Receptive AphasiaWernicke's Aphasia
Blood supply to Broca's areaMiddle Cerebral Artery
Blood supply to Wernicke's areaMiddle Cerebral Artery
Aphasia w intact comprehensionBroca's Aphasia
"Fluent" AphasiaWernicke's Aphasia
Aphasia with impaired comprehensionWernicke's Aphasia
Aphasia w intact comprehensionConduction Aphasia
"Fluent" AphasiaConduction Aphasia
Aphasia with poor repetitionConduction Aphasia
Aphasia due to lesion of arcuate fasciculusConduction Aphasia
Arcuate fasciculusTract that connects Broca's and Wernicke's area
Non-fluent aphasia AND Impaired comprehensionGlobal Aphasia
Lesion to non-dominant Broca's areaExpressive Dysprosody
Lesion to non-dominant Wernicke's areaReceptive Dysprosody
Lesion to dominant angular gyrus in parietal lobe (posterior, superior to Wernicke's area)Gerstmann syndrome
AgraphiaGerstmann syndrome
AlcalculiaGerstmann syndrome
Right-left disorientationGerstmann syndrome
Finger agnosiaGerstmann syndrome
Lesion to non-dominant parietal lobeHemispatial neglect
Frontal cortex lesionDishinibtion, Poor judgment, Reemergence of primitive reflexes
Prefrontal cortex lesionPt. unable to complete complex higher level tasks
Lesion to PPRF - eye deviates......away from side of lesion
Lesion to Frontal eye field - eye deviates......toward side of lesion
Lesion to superior colliculusParalysis of upward gaze (Parinaud's Syndrome)
Lesion to Reticular activating systemStupor and coma
Bilateral hippocampus lesionAnterograde amnesia
Destruction of mammillary bodiesWernicke-Korsakoff syndrome (Anterograde &or retrograde amnesia, ataxia, nystagmus, confabulation)
Bilateral amygdala lesionKl├╝ver-Bucy syndrome
Lesion to basal gangliaHypokinesis or hyperkinesis
Lesion to subthalamic nucleus of basal gangliaHemiballismus (involuntary flailing of arm)
Hemispheric cerebellar lesionIpsilateral movement problems
Cerebellar vermis lesionTruncal ataxia, dysarthria

Vascular events

Question Answer
Berry aneurysmADPKD
Berry aneurysmEhlers-Danlos syndrome
Berry aneurysmSmoking
Ruptured aneurysmMost common cause of non-traumatic SAH
TraumaMost common cause of SAH overall
SAH"worst headache of my life"
XanthochromiaYellow CSF from breakdown of bilirubin
Improves outcomes following SAHNimodipine (Dihydropyridine CCB)
Epidural HematomaTemporal fracture -> middle meningeal artery rupture
Epidural HematomaBleeding btwn dura and skull
Epidural HematomaCN III palsy
Epidural Hematoma"Lucid interval"
Subdural HematomaBtwn dura and arachnoid
Subdural HematomaRupture of bridging veins
Subdural HematomaLow pressure, slow bleed
Subdural HematomaElderly pts
Subdural HematomaAlcoholics
Subdural HematomaWhiplash + shaken baby syndrome
Subdural HematomaSpreads until midline; crescent shape on CT
Epidural HematomaLens shape on CT- trapped by dura
Parenchymal HemorrhageCocaine
Parenchymal HemorrhageSevere HTN
Parenchymal HemorrhageLenticulate striate (fragile) arteries
Parenchymal HemorrhageVascular malformation
Charcot-Bouchard micro-aneurysmLenticulate striate (fragile) arteries
Parenchymal HemorrhageAmyloid angiopathy
Parenchymal HemorrhageVasculitis
Interventricular hemorrhage Premies w low birth weight
Interventricular hemorrhage All infants born <30-32 wks gestational age need to be screened
Hemorrhagic strokeIntracerebral bleeding
Thrombotic strokeBlood clot occludes a vessel; aka "Ischemic stroke"
Thrombotic strokeAtherosclerotic plaque thrombus from carotids
Thrombotic strokeDVT w patent foramen ovale
Thrombotic strokeSeptic embolus (infective endocarditis)
Thrombotic strokeFat embolus from bone fracture
Transient ischemic attack (TIA)Transient episode of neurologic deficit due to ischemia - no infarction
Thrombotic stroketPA, Streptokinase, Urokinase (if viable candidate)
Most vulnerable to ischemic strokeCerebellum, neocortex, hippocampus, water shed areas