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NEURO ASSOCIATIONS

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laracrystalo's version from 2016-07-17 18:46

Section 1

Question Answer
increased AFPneural tube defects
confirmation after finding increased AFPcheck CSF for AChE
sonic hedgehog mutationsholoprosencephaly
cape-like distributionsyringomyelia (C8-T1) bilateral loss of pain and temp --fine touch preserved
posterior tongueCN X
back 1/3 of tongueCN IX taste and sensation; branchial arches 3 and 4
front 2/3 of tongueCN V3 sensation CN VII taste; branchial arches 1 and 2
axonal swellingwallerian degeneration (potential regeneration of axon in PNS)
reactive gliosisastrocyte response to neural injury
GFAP + astrocytes
extraocular movements during REM sleepPPRF
theta wavesN stage 1
bruxismsN stage 2
sleep spindles and k complexes N stage 2
nigh terrorsN stage 3
delta wavesN stage 3
penile clitoral tumescence REM
waves in REMbeta waves
dreamingREM
inhibits limbic systemprefrontal cortex
Osmotic demyelination syndromecentral pontine myelinolysis (from low to high your pons will die, from high to low, your brain will blow)
double crossing path so ipsilateral changescerebellum
romberg testsdorsal column (proprioception)
vitamin A excesspseudotumor cerebri
distorts fibers of corona radiatanormal pressure hydrocephalus
wet wobbly wackynormal pressure hydrocephalus
spastic paralysisUMN lesion
flaccid paralysisLMN lesion
clasp knifespaciticity (UMN)
babinksiUMN
fasciculationsLMN
mutation in superoxide dismutase 1ALS
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Section 2

Question Answer
Basal Gang direct pathD1 receptor --> increased movement
Basal Gang indirect pathinhibits movement
Snake-like movementsathetosis (hunting tons)
intention tremorcerebellar dysfunction
resting tremorparkinsons
alpha synucleincompose lewy bodies in parkinson
TRAPSTremor (pill rolling at rest), Rigidity (cogwheel), Akinesia, Postural instability, Shuffling gate
atrophy of caudatehuntington (lose ACh and GABA)
frontal horn dilatationhuntington
bilateral amygdala lesionshyperphagia, hypersexuality, hyperoral (kluver bucy)
associated with HSV 1kluver bucy
cannot balance check-bookfrontal lobe lesions
hemispacial negletnondominant parietal-temporal cortex
gerstmann syndromedominant parietal-temporal cortex lesion (hemispatial neglect)
CAN of beerConfusion, Ataxia, Nystagmus (Wernike encephalopathy affecting mammary bodies)--permanent memory loss
bilateral hippocampus lesionsanterograde amnesia
Parinaud syndromeparalysis of upward gaze (superior colliculi)
Kiesselbach plexusanterior nostril segment of nasal mucosa, sphenopalatine branch of maxillary --> frequent nosebleed site
fainting in panic attacksdecreased cerebral perfusion
cerebral perfusion primarily driven byPCO2
what decreases cerebral perfusion pressure?decreased blood pressure, increased ICP
what if CPP = 0?brain death, no cerebral perfusion
cause of lacunar infarctsHTN unmanaged (often of lenticulostriate arteries)
medial medullary syndromeinfarct of paramedic branches of ASA and vertebral arteries
Wallenberg syndrome(lateral medullary syndrome) PICA lesion --> nucleus ambiguus effects
lateral pontine syndromeAICA lesion --> facial nucleus --> facial droop
contralateral hemianopia with macular sparingPCA stroke
basilar artery stroke causeslocked in syndrome
12 hours after brain ischemiared neurons
branch points of arteries are lackingmedia --> saccular aneurysms
NMDA associated toxicityHuntington disease
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Strokes/aneurysms

Question Answer
increased in ADPKD and Ehlers Danlosberry aneurysms
Pcomm aneurysmCN III palsy (down and out with ptosis and mydriasis)
ruptured berry aneurysmsubarachnoid hemorrhage
bitemporal hemianopiacompression of optic chasm by berry aneurysm
common between Acomm and ACAberry aneurysms
lenticulostriate vesselslacunar infarct
associated with HTNlacunar and charcot-bouchard
common in basal gangliacharcot-bouchard micro aneurysm (intracerebral hemorrhage)
intracerebral hemorrhagecharcot-bouchard
middle meningeal artery ruptureepidural
bridging veins rupturesubdural
blood between dura and skullepidural
lucid intervalepidural
fracture to temporal boneepidural
talk and die syndromeepidural
blood between dura and arachnoidsubdural
crescent shaped hemorrhagesubdural
crosses suture linessubdural
does NOT cross suture linesepidural
crosses falx tentoriumepidural
does NOT cross falx tentoriumsubdural
AV malformationsubarachnoid
xanthochromic spinal tapblood or yellow (subarachnoid)
amyloid angiopathyintraparenchymal hemorrhage
premature babiesintraventricular hemorrhage of germinal matrix
risk of vasospasm due to rebelledsubarachnoid
most vulnerable to ischemic hypoxiahippocampus (pyramidal neurons 3, 5, 6) and also cerebellum (parkinje)
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NEUROCUTANEOUS DISORDERS

Question Answer
adenoma sebaceoustuberous sclerosis
shagreen patchestuberous sclerosis
ash leaf spotstuberous sclerosis
retinal lesionstuberous sclerosis
cardiac rhabdomyomatuberous sclerosis
cafe au last spotsneurofibromatosis I
meningiomaneurofibromatosis I
gliomaneurofibromatosis I
port wine stainsterge weber
mental retardationsterge weber
calcification of angioma in skullsterge weber
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BRAIN TUMORS

Question Answer
pseudopalisadingglioblastoma multiforme
butterflyglioblastoma (crosses corpus callosum)
crosses corpus callosumglioblastoma (butterfly)
GFAP +glioblastoma, oligodendrioma, pilocytic astrocytoma
from arachnoid cellsmeningioma
dural attachmentmeningioma
spindle cells in whorled patternmeningioma
psammoma bodiesmeningioma
surface of brainmeningioma
asymptomatic until presents with focal near signs or seizuresmeningioma
von hippel lindau associationhemangioblastoma
can cause polycythemiahemangioblastoma
produces EPOhemangioblastoma
thin walled capillaries closely arrangedhemangioblastoma
cerebellopontine angleschwannoma
S100+schwannoma
NF2bilateral schwannoma
fried egg cellsoligodendroglioma
chicken wire capillary patternoligodendroglioma
prolactinomapituatary adenoma
bitemporal hemianopiapituitary adenoma
posterior fossapilocytic astrocytoma
rosenthal fiberseosinophilic corkscrew fibers in pilocytic astrocytoma
homer-write rosettessolid small blue cells in medulloblastoma
drop metastases to spinal cordmedulloblastoma
compress 4th ventricle and cause hydrocephalusependymoma and medulloblastoma
perivascular pseudorosettesrod shaped basal ciliary bodies near nucleus in ependymoma
only childhood tumor supratentoriumcraniopharyngioma
remnant of rathke pouchcraniopharyngioma
tooth-enamel likecraniopharygioma
presents with parinaud syndromebrain germinoma (paralysis of conjugate vertical gaze due to lessen of superior colliculi)
kid tumor causing truncal ataxia and obstructive hydrocephalusmedulloblastoma
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STROKES

Question Answer
MCA strokecontralateral paralysis and loss of sensation of upper face and limb. Aphasia if in dominant hemisphere (L); Hemineglect if in non dominant (R)
ACA strokecontralateral lower limb paralysis and sensation
Lenticulostriate artery strokecontralateral hemiparesis/hemiplegia (LACUNAR INFARCT due to HTN)
ASA strokecontralateral hemiparesis, decreased proprio. tongue deviates ipsilaterally (hypoglossal dysfunction).
medial medullary syndromeinfarcts of paramedic branches of ASA
PICA strokevomiting, vertigo, nystagmus; degreased pain and temp ipsilateral face and contra body; dysphagia, hoarseness, decreased gag, ipsilateral hornets, ataxia, dysmetria
wallenberg syndromelateral medullary syndrome caused by PICA stroke
nucleus ambiguus effectsPICA stroke (wallenberg syndrome)
AICA strokevomiting, vertigo, nystagmus, facial paralysis, decreased lacrimation, salivation, taste from ant 2/3 tongue, ipsialteral pain and temp of face, contra pain and temp body, ataxia, dysmetria
lateral pontine syndromeAICA stroke
facial droopAICA stroke facial nucleus lesion
PCA stroke contralateral hemianopia with macular sparing
locked in syndromebasilar artery stroke. preserved consciousness, blinking, but quadriplegia and loss of voluntary facial, mouth and tongue movements
AComm stroke visual field defects. Lesions are typically aneurysms, not strokes!
common sites of saccular berry aneurysms are...Acom and PCom arteries.
Down and outCN III palsy with ptosis and mydriasis due to PCom stroke
aphasiaMCA stroke (usually L)
leg weakness more than arm weaknessACA stroke
limb ataxiaPCA stroke
ipsi face sensory loss with contra limb sensory lossPCA stroke
nonhemorrhagic stroke txless than 3 hrs --> thrombolytics more than 3 hrs --> ASA
hemorrhagic stroke tx?nothing. supportive,
if person is already on ASA at time of stroke, how do you treat?add dipyridamole or switch to clopidogrel
every person with a stroke should be on a ...statin
carotid operation cutoffsdo endarterectomy if > 70% occlusion. treat medically if < 50% occluded. Do nothing (give meds) if 100% occluded
loss of contralateral pain and temperature, loss of ipsilateral position and vibratory sensebrown sequard
tx spinal trauma?steroids
loss of DTRs at level of injury, followed by hyperreflexiaspinal trauma
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RANDOM UWORLD NEUROLOGY

Question Answer
succinylcholine complicationcan cause life threatening hyperkalemia. NMJ blocker. avoid in burn, crush or demyelination patients
what may still be present in a brain dead person?DTRs (still have some spinal cord function)
what does pronator drift indicate?pyramidal tract disease (UMN). if in young woman, think MS
sharp wave complexesCreutzfeldt jacob
elevated 14-3-3 in CSFcreutzfeldt jacob
what to do for increased ICP?elevate head, hyperventilate (decreases CO2 causing cerebral vasoCONSTRICTION), mannitol, remove CSF, sedation
what kind of injury is seen in brain in prolonged status epilepticus?cortical laminar necrosis
how do you treat cyanide toxicity?sodium thiosulfate
how can OA cause neuro problems?cervical spine degenerative disc disease can cause pain with mvmd of neck and lead to sensation of spinning after turning the head
baby with bulging fontanelle first move?give steroids, then get CT/MRI
low salt diet is treatment for ?meniere
meniere sxhearing loss, vertigo, nystagmus
what to check for CSF leak?beta 2 transferrin
otosclerosisconductive hearing loss in 20-30 yo women
tx otosclerosishearing amplification or surgical stapedectomy
fasciculation is a ...signLMN
hemiparesis after seizure?todd paralysis
postictal ABG?respiratory acidosis due to hypoventilation
cholesteatomanew onset hearing loss, chronic ear drainage despite antibiotics. Granulation tissue and skin debris can be seen on otoscope
dx cholesteatoma?CT
tx cholesteatoma?surgery
tx lambert eaton?plasmapheresis and immunosuppressants, treat small cell cancer
lambert eaton antibodies?presynaptic calcium channels
myasthenia gravis antibodies?postsynaptic ACh channels (decreased receptors)
acute migraine treatment?sumitrptan?
acute migraine with vomiting treatment?antiemetics (prochlorperazine)
headache behind eyecluster
downs syndrome with UMN findings?atlantoaxial instability
presbycusisage related sensorineural hearing loss, progressive bilateral high frequency loss with subjective bilateral tinnitus
1 ring enhancing lesion?toxo (EBV DNA) or CNS lymphoma if immunocompromised, brain abscess if immunocompetent
non enhancing lesions in HIV+progressive multifocal leukoencephalopathy (JC virus)
hoarseness nerverecurrent laryngeal
tongue palsy nervehypoglossal nerve (submandibular salivary gland surgery)
jaw asymmetry nerveunilateral paralysis of muscles of mastication
winged scapula nervelong thoracic
facial droop nerveCN VII in dammage to parotid dissection
strabismus nerveimproper eye alignment due to disorder of extra ocular n CNIII, IV, VI
seizure provoked by hyperventilationabsence
3hz spike and waveabsence seizure
tx absence seizuresethosuximide or valproate
treat infantile spasmsprednisone
partial seizures txgabapentin
syringomyelia associated withchair malformation
loss of pain/temp in cavelike distributionsyringomyelia
meningomyelocoele related tochairi II
anterior cord syndrome cause?burst fracture of vertebra
anterior cord syndrome sxloss of motor function with loss of pain and temp on both sides below the lesion with INTACT PROPRIOCEPTION
central cord syndromeelderly with hyperextension of neck and preexisting degenerative changes. weaker upper extremities with localized pain and temp decrease
elderly hyperextension neckcentral cord syndrome
increased RBC on CSFHSV
tx pseudotumor cerebri?stop OCPs, vitamin A, start acetazolamide, add furosemide if needed, and if refractory to meds, do LP shunting or optic nerve sheath decompression
hemineglect lesionnon dominant parietal lobe
what side do hemineglect pay attention to?ignore the contralateral side
tx physiologic tremoravoid caffeine, anxiety
tx essential tremorpropranolol, primidone, topiramate
early carvidopa/levodopa side effects?hallucinations, dizziness, head ache, agitation
multiple systems atrophy?parkinsonism and orthostatic hypotension
brain in panic disorderamygdala
brain in PTSDhippocampus
brain in autismincreased brain volume
brain in OCDbasal ganglia orbitofrontal cortex
brain in schizophreniaenlarged ventricles
brain in huntingtonhyper intense caudate
tx huntingtonhaloperidol
brain in alzheimersdiffuse cortical and subcortical brain atrophy, esp hippocampus
cushing reflexHTN, bradycardia, respiratory depression suggests brainstem compression due to increased ICP
LP shows increased protein?guillon barre
tx guillon barre?IVIG, plasmapheresis, monitor resp failure with spirometry
guillon barre paralysis vs tick born paralysis?GB is symmetrical, tick is asymmetrical
bilateral trigeminal neuralgia?think MS
corneal sensation nerveCN V1
if patient is pronounce brain dead, do you need permission to take off ventilator?no
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