Create
Learn
Share

Neurology 3

rename
jmanderson's version from 2016-04-16 17:26

Section

Question Answer
physiology of accomodationfocus on near objects -> ciliary muscles tighten -> zonular fibers relax -> lens becomes more convex
uveitis is inflammation ofuveal coat (iris, ciliary body, chorioid)
uveitis associated withsarcoid, RA, juvenile idiopathic arthritis, TB, HLA-B27 associated conditions
retinitis isretinal edema and necrosis leading to scar
retinitis is associated withimmunosuppression
viruses associated with retinitisCMV, HSV, HZV
central retinal artery occlusion causesacute, painless monocular vision loss; retinal whitening with cherry-red spot
presbyopiadecreased ability to change focus during accommodation due to sclerosis and decreased elasticity
memorize

Section

Question Answer
collects aqueous humortrabecular meshwork, then canal of schlemm
produces aqueous humorciliary epithelium
ciliary epithelium receptorbeta
pupillary sphincter receptorM3
pupillary dilator receptoralpha-1
memorize

Section

Question Answer
open/wide angle glaucoma symptomspainless; peripheral then central vision loss, usually with increased IOP, optic disc atrophy with cupping
open/wide angle glaucoma associated withbeing old, being black, high IOP
secondary causes of open/wide angle glaucomauveitis, trauma, corticosteroids, vasoproliferative retinopathy
obstruction in open/wide angle glaucomaobstructed outflow at trabecular meshwork
obstruction in closed/narrow angle glaucomalens against iris obstructs normal aqueous flow through pupil; fluid buildup behind iris pushes peripheral iris against cornea, impeding flow through trabecular meshwork
symptoms of chronic closed/narrow angle closureoften asymptomatic, with damage to optic nerve and peripheral vision
symptoms of acute closed/narrow angle glaucomavery painful, sudden vision loss, halos around eye, rock-hard eye, frontal headache
contraindicated in acute closed/narrow angle glaucomaepinephrine (mydriatic effect)
memorize

Section

Question Answer
CN III damageeye looks down and out; ptosis, pupillary dilation, loss of accomodation
CN IV damageeye moves upward, particularly with contralateral gaze and ipsilateral head tilt (problems going down stairs)
CN VI damagemedially directed eye that cannot abduct
testing extraocular muscle function, clockwise starting at upper nasalIO, MR, SO, IR, LR, SR
memorize

Section

Question Answer
1st neuron in miosisEdinger-Westphal nucleus to ciliary ganglion via CN III
2nd neuron in miosisshort ciliary nerves to pupillary sphincter muscles
1st neuron in mydriasishypothalamus to ciliospinal center of Budge (C8-T2)
2nd neuron in mydriasisexit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels)
3rd neuron in mydriasisplexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscle
memorize

Section

Question Answer
pathway of pupillary light reflexlight enters retina -> signal via CN II to pretectal nuclei -> activate bilateral Edinger-Westphal nuclei -> pupils contract bilaterally
marcus gunn pupilafferent pupillary defect; less bilateral pupillary constriction when light is shone in affected eye
memorize

Section

Question Answer
layout of CN IIImotor portion central, parasympathetic portion peripheral
signs of CN III motor injuryptosis, "down and out" gaze
motor output to ocular muscles affected primarily by vascular disease due todecreased diffusion of oxygen and nutrients to interior fibers
signs of CN III sympathetic output lesiondiminished or absent pupillary light reflex, blown pupil
fibers of CN III sympathetic output are first affected bycompression (PCA aneurysm, uncal herniation)
memorize

Section

Question Answer
retinal detachmentseparation of neurosensory layer from outermost pigmented epithelium -> degeneration of photoreceptors and vision loss
secondary causes of retinal detachmentretinal breaks, diabetic traction, inflammatory effusions
breaks are more common in patients withhigh myopia
breaks are often preceded byposterior vitreous detachment (flashes and floaters)
memorize

Section

Question Answer
symptoms of age related macular degenerationdistortion (metamorphopsia) and eventual loss of central vision (scotomas)
dry macular degeneration caused bydeposition of yellowish extracellular material beneath retinal pigment epithelium (drusen); gradual loss of vision
prevent progression of dry macular degeneration withmultivitamin and antioxidant supplements
wet macular degeneration due tobleeding secondary to choroidal neovasularization; rapid loss of vision
treatment of wet macular degenerationanti-VEGF injections, laser
memorize

Section

Question Answer
right or left anopiaoptic nerve
bitemporal hemianopiaoptic chiasm
left or right homonymous hemianopiaoptic tract, or lesion to both meyers loop and dorsal optic radiation
upper quadrantic anopiameyer's loop in temporal lobe (MCA)
lower quadrant anopiadorsal optic radiation in parietal lobe; MCA
hemianopia with macular sparingPCA infarct in occiput
central scotomamacular degeneration
meyer's loopinferior retina; loops around inferior horn of lateral ventricle
dorsal optic radiationsuperior retina; shortest path via internal capsule
memorize

Section

Question Answer
medial longitudinal fasciculus allows talk betweenCN VI and CN III nuclei
MLF is highly myelinatedlesions seen in patients with demyelination
abducting eye getsnystagmus
memorize

Dementia

Question Answer
patients at greater risk of Alzheimer'sDown syndrome
early onset familial Alzheimer'sAPP (21), presenilin-1 (14), presenilin-2 (1)
late onset familial Alzheimer'sApoE4 (19)
protective protein in familial Alzheimer'sApoE2 (19)
decreased neurotransmitter in Alzheimer'sACh
extracellular beta-amyloid core may causeintracranial hemorrhage
Pick's symptomsdementia, aphasia, parkinsonian aspects
pick's sparesparietal lobe and posterior 2/3 of superior temporal gyrus (frontotemporal dementia and atrophy)
pick's bodiesspherical tau protein aggregates
lewy body dementia symptomsparkinsonism with dementia and hallucinations
defect in lewy body dementiaalpha-synuclein defect
creutzfeld-Jakob disease symptomsrapidly progressive (weeks to months) dementia with myoclonus; "startle myoclonus"
creutzfeld-jakob pathologyspongiform cortex, beta-pleated sheets of prions resistant to proteases
memorize

demyelination

Question Answer
classic SIIINs of multiple sclerosisscanning speech, intention tremor, internuclear opthalmoplegia, nystagmus
CSF findings in MSincreased protein (IgG)
diagnostic in MSoligoclonal bands
gold standard imaging technique in MSMRI
imaging finding in MRI in MSperiventricular plaques (areas of oligodendrocyte loss and reactive gliosis) with destruction of axons
treatment of MSbeta-interferon, immunosuppression, natalizumab
treatment for neurogenic bladder in MScatheterization, muscarinic antagonist
treatment for spasticity in MSbaclofen, GABA receptor agonist
cell destroyed in acute inflammatory demyelinating polyradiculopathyschwann cells
pathogens associated with Guillain-Barrecampylobacter jejuni and CMV (molecular mimicry)
majority of guillain-barre patients recover withinweeks to months
these functions may be severely affected in guillain-barreautonomic; cardiac irregularities, hypertension, hypotension
critical in guillain-barrerespiratory support
additional treatment of guillain-barreplasmapheresis, IV immune globulins
findings in guillain-barrealbuminocytologic dissociation; increased CSF protein with normal cell count. papilledema (increasd protein)
progressive multifocal leukoencephalopathy (PML) pathologydemyelination of CNS due to destruction of oligodendrocytes
PML associationsJC virus, seen in 2-4% of AIDS patients due to latent viral reactivation
PML disease courserapidly progressive, usually fatal
acute disseminated postinfectious encephalomyelitis pathologymultifocal perivenular inflammation and demyelination after infection
acute disseminated postinfectious encephalomyelitis associated infectionsmeasles, VZV
acute disseminated postinfectious encephalomyelitis associated vaccinationsrabies, smallpox
genetics of metachromatic leukodystrophyautosomal recessive lysosomal storage disease, most commonly due to arylsulfatase A deficiency
pathology of metachromatic leukodystrophybuildup of sulfatides leads to impaired production of myelin sheath
charcot-marie-tooth diseaseprogressive hereditary nerve disorders related to defective production of proteins in peripheral nerves or myelin sheath
krabbe's disease geneticsautosomal recessive lysosomal storage disease due to deficiency of galactocerebrosidase
krabbe's disease pathologybuildup of galactocerebroside destroys myelin sheath
memorize

SZ

Question Answer
status epilepticuscontinuous seizure for > 30 min, or recurrent seizures without regaining consciousness for > 30 min. medical emergency
most common area for partial (focal) seizures to originatemedial temporal lobe
simple partial seizureconsciousness intact; can be motor, sensory, autonomic, psychic
complex partial seizureimpaired consciousness
memorize

SZ II

Question Answer
absence seizure (petit mal)3 Hz, no postictal confusion, blank stare
myoclonic seizurequick, repetitive jerks
tonic-clonic (gran mal) seizurealternating stiffening and movement
tonic seizurestiffening
atonic seizuredrop seizure; falls to floor
memorize

Section

Question Answer
headache that can induce horner's syndromecluster headaches
treatment for cluster headachesinhaled oxygen, sumatriptan
molecular mediators of migraine headachessubstance P, CGRP, vasoactive peptides
abortive therapy for migrainetriptans (e.g., sumatriptan)
prophylactic therapy for migrainepropranolol, topiramate
memorize

Section

Question Answer
peripheral vertigo etiologyinner ear; semicircular canal debris, vestibular nerve infection, meniere's disease
positional testing in peripheral vertigodelayed horizontal nystagmus
central vertigo etiologybrain stem or cerebellar lesion; stroke affecting vestibular nuclei or posterior fossa tumor)
positional testing in central vertigoimmediate nystagmus in any direction; may change directions
memorize

Neurocutaneous disorders

Question Answer
sturge-weber syndrome occurssporadically
sturge-weber findingsport-wine stains (nevus flammeus) typically in V1 distibution; ipsilateral leptomeningeal angiomas, pheochromocytomas
sturge-weber can causeglaucoma, seizures, hemiparesis, mental retardation
tuberous sclerosis HAMARTOMASHamartomas in CNS and skin, Adenoma sebaceum (cutaneous angiofibromas), Mitral regurgitation, Ash-leaf spots, cardiac Rhabdomyoma, Tuberous sclerosis, autosomal dOminant, Mental retardation, renal Angiomyolipoma, Seizures
neurofibromatosis type I geneticsautosomal dominant, 100% penetrant, variable expression. mutated NF1 gene on chromosome 17
neurofibromatosis type 1 findingscafe-au-lait spots, lisch nodules (pigmented iris hamartomas), neurofibromas in skin, optic gliomas, pheochromocytomas
von Hippel-Lindau disease geneticsautosomal dominant, mutated tumor suppressor VHL gene on chromosome 3
von Hippel-Lindau findingscavernous hemangiomas in skin, mucosa, organs; bilateral renal cell carcinoma, pheochromocytomas
locations of hemangioblastomas in von Hippel-Lindauretina, brain stem, cerebellum
memorize

Adults primary brain tumors

Question Answer
histologic appearance of glioblastoma multiformepseudopalisading pleomorphic tumor cells bordering central areas of necrosis and hemorrhage
butterfly gliomaglioblastoma multiforme that crosses corpus callosum
location of glioblastoma multiformecerebral hemispheres
life expectancy in glioblastoma multiformeless than 1 year
stain on astrocytes in glioblastoma multiformeGFAP
histologic appearance of meningiomaspindle cells concentrically arranged in whorled pattern; psammoma bodies
most common locations of meningiomasconvexities of hemispheres near surface, parasagittal region
clinical course of meningiomastypically benign and resectable. often asymptomatic, but can present with seizures or focal signs
meningiomas arise fromarachnoid cells external to brain parenchyma, and may have dural attachment (tail)
disease featuring bilateral acoustic schwannomasneurofibromatosis type 2
common location of schwannomacerebellopontine angle (CN VIII, acoustic neuromas)
positive marker in schwannomaS-100
treatment of schwannomaresection or stereotactic radiosurgery
most common location of oligodendrogliomafrontal lobe
course of oligodendrogliomarare, slow growing
capillary pattern of oligodendrogliomachicken wire
oligodendrocyte histology in oligodendrogliomafried egg cells; round nuclei with clear cytoplasm, often calcified in oligodendroglioma
memorize

Childhood primary brain tumors

Question Answer
pilocytic astrocytoma characteristic histologyrosenthal fibers; eosinophilic, corkscrew fibers
pilocytic astrocytoma grosscystic + solid, usually well circumscribed
typical location of pilocytic astrocytomaposterior fossa (e.g., cerebellum), but may be supratentorial
positive marker in pilocytic astrocytomaGFAP
prognosis of pilocytic astrocytomabenign, good prognosis
histology of medulloblastomahomer-wright rosettes. small blue cells
treatment of medulloblastomaradiosensitive
medulloblastoma grosssolid
origen of medulloblastomaprimitive neuroectodermal tumor
course of medulloblastomahighly malignant
medulloblastoma can cause hydrocephalus bycompressing 4th ventricle
characteristic metastases of medulloblastoma"drop metastases" to spinal cord
histology of ependymomaperivascular pseudorosettes; rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus
common location of ependymoma4th ventricle (can cause hydrocephalus)
prognosis of ependymomapoor
most common location of hemangioblastomacerebellum
hemangioblastomas associated with von Hippel-Lindau when found withretinal angiomas
hemangioblastomas can produceEPO -> secondary polycythemia
histology of hemangioblastomasfoamy cells and high vascularity
craniopharyngioma derived from remnants ofRathke's pouch
craniopharyngioma histologic characteristiccalcification common
craniopharyngioma clinical coursebenign, can cause bitemporal hemianopia. most common childhood supratentorial tumor
memorize

Section

Question Answer
cingulate (subfalcine) herniationherniation under falx cerebri
cingulate herniation can compressACA
uncal herniation lobemedial temporal lobe
clinical result of cerebellar tonsillar herniationcoma and death from brainstem compression
transtentorial herniation isdownward
memorize