Neuropathology 1 Flashcards

Question

A: Frontal eye fields are located in the __ \_\_ ___ and are considered the \_\_\_\_\_\_\_. Frontal eye fields influence ____ nuclei using ___ and \_\_\_\_ B: Lesioned [Frontal Eye Fields] will lead to what?

Answer 1

A: Frontal eye fields are located in the MIDDLE FRONTAL GYRUS and are considered the [center for Voluntary eye Saccades]. FEF influence Ocular nuclei using [SUP colliculus] and PPRF B: Lesioned FEF ----\>inability to look contralaterally (with reflex eye movements intact)

Answer 2

\*\*[**ASCENDING** Medial Longitudinal Fasciculus] (MLF)\*\* 1. Arises from [medial vestibular nuclei] and [SUP vestibular nuclei] 2. Projects BILATERALLY to CN3, 4 and 6's nucleus! 3. Coordinates - [conjugate Eye mvmnts] (via reticular formation) +/- [Head mvmnt = i.e. vestibuloocular reflex] 4. \*\*\*CROSSED Ascending MLF = EXCITES XtraOcular m. vs. \***UN**Crossed Ascending MLF= **inhibits** xtraocular m.

Answer 3

1. Lateral vestibulospinal tract Arises from [lateral vestibular nucleus] & descends ipsilaterally to ALL spinal cord levels to activate EXTENSOR motor neurons 2. MEDial vestibulospinal tract is the MAJOR component of DESCENDING MLF and comes from [medial vestibular nucleus] . Projects to CERVICAL spinal cord levels to innervate neck muscles 3. Spinovestibular tract = collaterals of spinoCEREbellar projections

Answer 4

A: Stereocilia hair cells of the [Crista ampullaris] produce a gelatinous [CUPULA] to cover and protect them. B: ANT canal is parallel to POST canal from other side. Horizontal canals from both sides form functional pair together

Answer 5

A: Equilibrium is Maintained and Controlled by 1. Vestibular apparatus of internal ear 2. Vision 3. Proprioreception [It only requires 2 out of the 3! to maintain Balance] ------------------------------------------------------------------------------ B: **Vertigo** Sx = **DNP** = **D**izziness, **N**V and **P**allor B2: Causes: [Degenerated Ca+ Crystal Otoliths] vs. [Acute Labyrinthitis]

Answer 6

5 Sensory Receptors that utilize the [Dorsal **Spinocerebellar** Tract] Pathway for **UNCONSCIOUS IPSILATERAL PROPRIORECEPTION** MMM JRP 1. **M**eissner's Corpuscle 2. **P**acinian Corpuscle 3. **M**erkels Disk 4. **R**uffini 5. **J**oint Receptors 6. **M**uscle Spindles

Answer 7

[Free Nerve Ending] Receptor: 1. **NOT** Encapsulated ("*Free Hairy Merkel*") 3. Pain/Temp 4. Deep skin & viscera

Answer 8

[Merkel's Disk] Receptor: 1. **NOT** Encapsulated (*"Free Hairy Merkel"*) 3. Touch 4. Feet/hands/genitalia / lips

Answer 9

[Hair Follicles] Receptor: 1. **NOT** Encapsulated ("*Free Hairy Merkel*") 3. Touch 4. Anything with Hair

Answer 10

[Meissner's Corpuscle] Receptor: 1. Encapsulated !! 3. 2 Point Discrimination 4. [hair*LESS* Skin] / joints / ligaments / fingertips

Answer 11

[Pacinian Corpuscle] Receptor: 1. Encapsulated !! 3. Vibration 4. Fingers & Toes / mesenteries / peritoneum

Answer 12

[Ruffini Ending] Receptor: 1. Encapsulated !! 3. Stretch / pressure 4. Dermis

Answer 13

[Joint] Receptor: 1. Encapsulated !! 3. Joint Position 4. [Joint Capsules] & Ligaments

Answer 14

[Neuromuscular Spindle] Receptor: 1. Encapsulated !! 3. Limb muscle Stretch 4. Muscles

Answer 15

[Golgi Tendon Organs] Receptor: 1. Encapsulated !! 3. MUSCLE Tension 4. Muscle tendon Junctions

Answer 16

\*\*[Substantia gelatinosa]\*\* ºIs "Pain Gate keeper" & filters sensory information by synapsing on dendrites in [Nucleus Proprius] ºHomologous to [spinal trigeminal nucleus] ºAxons ascend & descend 1 to 4 segments in [Dorsolateral Fasciculus /Zone of Lissauer]

Answer 17

1. [Pain, temperature, position sense, vibration from skin/body wall and pressure] come from the GSA component 2. [Motor projections to Viscera, Glands & blood vessels] = GVE component 3. Pain, sensations of FULLNESS/STRETCH from viscera come from the GVA component \*Alar Plates Derive into SENSORY/DORSAL ROOT {Afferent and Alar = Sensory} \*Basal Plates derive into MOTOR/VENTRAL Root

Answer 18

A: The CLOSED Medulla is the part of Medulla NOT UNDER 4th Ventricle B: [Corpora Quadragemini] are 4 Colliculi tht sit on DORSUM of Midbrain and is AKA [TECUM OF MIDBRAIN]. \*\*SLOW = SUP colliculi talk with [Lateral geniculate] for Optic "WVision" \*\*AIM = Auditory system uses Inferior Colliculi which talks with [MEDIAL geniculate] -------------------------------------------------------------------------------------- C:3 Cerebellar Peduncles 1- \*\*SUP Cerebellar Peduncle = MOSTLY EFFERENT except [Ventral Spinocerebellar tract] and is in midbrain 2-MIDDLE cerebellar Peduncle= LARGEST, is afferent and attaches to Pons 3- inf cerebellar peduncle= afferent and attached to Medulla -------------------------------------------------------------------------------------- D: \*\*SUP Cerebellar Peduncle DECUSSATES inbetween [substantia nigra] of caudal MIDBRAIN ...on its way to [Red Nucleus of midbrain]

Answer 19

A: [Crus Cerebri Cerebral Peduncles] are on the VENTRAL Midbrain and responsible for connecting Cerebrum with brainstem/spinal cord B: Infundibulum Stalk hangs Between [Crus Cerebri Cerebral Peduncles] of midbrain and suspends PITUITARY GLAND ventrally C: Cerebellar Peduncles **would stain BLACK** with myelin stain because they're white fibers lol

Answer 20

A: "Pontocerebellar mossy fibers" = Cortex fibers that travel to [Pontine Gray Nuclei] ---\>then contralaterally travel to [MIDDLE Cerebellar Peduncle] ------------------------------------------------------------------------------- C: [Spinal CN11] goes up thru Foramen Magnum and then goes back out Cranium [Jugular Foramen] -------------------------------------------------------------------------------------- D: When the Temporal Lobe UNCUS squishes [Oculomotor CN3] ---\> LATERAL GAZE! (because CN6 Abducens just takes over)

Answer 21

1. The **PICA** (*Daughter of Vertebral a.*) perfuses Lateral Medulla 2. Can Cause [**Lateral Medullary syndrome of Wallenberg**] 3. causes ischmia and ---\> **L**ucy **H**as **2** **VPN** **L**imb Dysmetria *ipsilateral*- from [inf cereberllar peduncle] **H**orner's Syndrome *ipsilateral*- from [descending sympathetic fibers] **2**TVP loss *Contralaterally*-from [medial lemniscus involvement] [**V**ocal Cord/Palatal Weakness] *ipsilateral*- from [nc. ambiguous] [**P**ain & Temp] impairment *ipsilateral face/Contralateral body (STT)*- from [descending CN5, n & t] & STT **N**ystagmus- from vestibular nc.

Answer 22

1. [NST] Nucleus of Solitary Tract are in the [Medulla] 2. Taste [upper NST] &; GVA Sensation [Lower NST]

Answer 23

PERFUSIONS! 6. Olive perfused by [PICA or actual *Parent* Vertebral a.] 7. Basal Pons perfused by Basilar a. 8. [Middle cerebellar peduncle] perfused by [AICA and Basilar a.] 9. [Crus Cerebri Cerebral Peduncle] perfused by PCA {POST cerebral a.} 10 .[inf cerebellar peduncle] (AKA RESTIFORM BODY) perfused by PICA

Answer 24

A: Lower Motor Neurons are Motor neurons of the Brainstem & Spinal Cord. They are arranged into 4 columns and release ACETYLCHOLINE onto nicotinic receptors of target m. Lower Motor Neurons are recruited based on size & Force B: 4 Column Arrangement: 1. medial LMN--\>axial trunk m. 2. Lateral LMN---\>Distal Limb m. (extremities) 3. Dorsal LMN---\>FLEXORS 4. venTral LMN-------\>exTensors

Answer 25

Descending pathways = CONTROL SYSTEM in spinal cord LMNs A: Lateral CST=ALL Excitatory (Glutamate is the transmitter) B: Vestibulospinal= Head mvmnt & postural adjustments C: Reticulospinal= locomotion & postural control D: Tectospinal = reflex of turning head in response to visual/auditory stimuli E: Rubrospinal= no significance in humans

Answer 26

A: Cortico**BULBar** tract (AKA Cortico**nuclear** tract) is an UPPER MOTOR NEURON that descends ANterior to Corticospinal tract. It usually ends on interneurons of [Reticular formation] but sometimes ends on [motor neurons of CN] inside the brainstem. B: Oculomotor, Trochlear & Abducens nucleus does NOT receive DIRECT CorticoBULBar innervation.

Answer 27

Cortex Origin of Upper Motor Neuron for CN nuclei involving: 1. Chewing ex. UMN for Chewing (CN5) comes from [**Both** BUT More of 1 side] before reaching Nucleus 2. *Facial Droop vs. Bell's Palsy*: UMN come from **BOTH Cortex** before reaching CN7 Nucleus --\> **ONLY 1 LMN** Innervates **Entire** Face *ipsilaterally* * Facial Droop= Lesion of Facial **UMN*** * Be**LL**s Palsy= **Lesion of Facial LMN = complete face droop*** 3. [speaking & swallowing]: UMN come from BOTH Cortex before reaching CN9 and CN10 Nucleus 4. tongue mvmnt: UMN comes from [Both BUT More of 1 side Cortex] before reaching CN12 Nucleus

Answer 28

Make up 3% of [CST-Corticospinal Tract] and are concentrated there Primary Motor Cortex makes up 50% of CST and the rest comes from [Adjacent Frontal motor and Parietal areas]

Answer 29

Area 44 = Broca’s Area 22 = Wernicke’s Area 41 = Heschel’s Gyrus / Primary Auditory Cortex Hearing is BILATERAL above the cochlear nucleus = why it’s hard to knock out \*\*99% of hearing comes from inner row Outer row = displacement sensitive so controls tectorial membrane

Answer 30

The **INTERNAL CAROTID Artery** (ANTERIOR circulation) **perfuses MOST of Cerebrum** (70%). (*Vertebral a. perfuse 30%*) It bifurcates into..... [Anterior Cerebral a.]----\>medial cortex and [middle cerebral a.]--\>lateral cortex B: Daughter branches: 1) ophthalmic artery 2) ANT Choroidal a. 3) POST communicating a.

Answer 31

The VERTEBROBASILAR system (POSTERIOR circulation) perfuses Brainstem, Cerebellum & Spinal Cord. B: 2 Vertebral a. Join---\> 1 Basilar ARtery--\>Bifurcates into PCA [POST cerebral a.] C: \*Basilar branches = [(AICA) ANT inf. cerebellar a.] & [(SCA)SUP cerebellar a.] \*\*Vertebral branches = PAP! (, ASA PSA, PICA) -ANT Spinal a. -POST Spinal a. -POST inferior cerebellar a.

Answer 32

80% of strokes\<-----[**middle cerebral a.**] which is a bifurcated branch of INTERNAL CAROTID ARTERY. [**middle cerebral a**.] perfuses lateral cortex B: [POST cerebral a.] perfuses Occipital lobe & Temporal Lobes (memory lost)

Answer 33

{Circle of Willis} Interconnects ANTERIOR and POSTERIOR circulations. It forms 1. [ANT communicating a.] between the two [ANT cerebral a.] and [POST communicating a.] between [Internal carotid] and [POST cerebral a.] B: [Circle of Willis] surrounds brain base it gives rise to small perforating ganglion arteries (*via MCA*) called [**lenticulostriate a.**] --*perfuse*---\> **[deep cerebral structures (*internal capsule/basal ganglia/thalamus*)]** C: entry points of perforating a. on Brain Base

Answer 34

Blood Brain Barriers are formed by [ASTROCYTE GLIAL CELLS] which use TIGHT junctions between ENDOTHELIAL cells and [ENDOTHELIAL CELL LAMINA] to "gatekeep" blood coming from from CAPILLARIES(which never make direct contact with brain tissue) B: Pleuripotent cell that gives rise to other blood vessels and regulates endothelial cells. Located [under basal lamina] but [ON TOP OF ENDOTHELIUM]

Answer 35

Brain is 2% Body Weight BUT uses 25% Oxygen! *-Control of Blood Flow:* A: metabolic: INC neuronal activity---\>Glutamate released ---\>[astrocyte feet receptor activation]---\>VasoDIOLATES factors released at feet ---\> applied to vessels to DILATE VESSELS IN THAT AREA B: AUTOREGULATION: Arterial & Smooth muscle cell mediated C: neuronally: autonomic fibers innervate Cerebral vessels D: Normally= [55 ml Blood/100 g in 1 minute] 20 ml = neurons stop electrically firing 10 ml = NECROSIS OF BRAIN!

Answer 36

Valveless Cerebral Veins---(drain into)---\>[DURA VENOUS SINUSES]----(drain into)----\> [INTERNAL JUGULAR VEIN] + [Basilar Venous Plexus] B: [Basilar Venous Plexus] mostly drains BASE OF BRAIN and communicates with [SPINAL CORD EPIDURAL VENOUS PLEXUS] C: [Cerebellum and BrainSTEM] drain their veins into the [GREAT VEIN OF GALEN]! (along w/Deep Veins)

Answer 37

\*\*\*\*Superficial Veins\*\*\* 1. Superficial group = Dumps INto Superior/inferior Sagittal Sinuses 2. Inferior group= empties with transverse AND cavernous sinus ----\>[SUP/inf sagittal sinus]----\> \*\*[SINUS CONFLUENCE]\*\*----\>Transverse sinuses---\>IJV vs. Deep Veins = empty into [Internal cerebral Veins] ---\>[GREAT VEIN OF GALEN]-----\>Straight Sinus----\>\*\*[SINUS CONFLUENCE]\*\*-----\>Transverse sinuses ------\>IJV

Answer 38

**SubArachnoid Hemorrhage** going into the Cisterns

Answer 39

A: **Symmetrical** Nystagmus B: **A**symmetrical nystagmus C: Rotating in a swivel chair and then suddenly stopping

Answer 40

A: Be**LL**s Palsy= _Sudden and Non-traumatic_ Lesion of Facial **L**MN = **complete** face droop + [possible taste loss over *ipsilateral* ANT Tongue (*chorda tympani branch*)] + [possible *ipsilateral* hyperacusis (*stapedius branch*)] C: [Facial CN7 inflammation in petrous bone (*possibly viral*)] D: Steroids

Answer 41

**FTSDL** ## Footnote [**F**acial Paralysis *ipsilateral* / **T**aste loss / **S**ound sensitivity INC / **D**eafness&Tinnitus / **L**ateral Gaze impairement] 1. [Facial CN7 LMN] = **F** 2a. [*Petrous Bone:* Chorda tympani fibers] = **FT** 2B. [*Petrous Bone*: Stapedius fiber] = **FTS** 3. [*CAAN-* *C*erebellopontine *A*ngle *A*coustic *N*euroma] = **FTSD** 4. [Pontine Lesion] = **FTSDL**

Answer 42

A. **Brain stem lesion** --\> - ipsilateral CN deficit - *Contralateral* UMN limb weakness B: **R Pontine Infarct**--\> - [R LMN Facial Weakness from CN7 deficit] - [L Hemiparesis from (Corticospinal Pyramidal tract) deficit]

Answer 43

A. [**Medial Midbrain of Weber syndrome**] \*\*Occlusion of [POST Cerebral a.] --\> 1. *ipsilateral* CN3 lesion 2. *Contralateral* hemiplegia (*Cerebral Peduncle*)

Answer 44

1st: Place vibrating tuning fork on mastoid process of suspected side. Pt should hear vibrations in that ear = **Bone** conduction route intact 2nd: While tuning fork is still vibrating move prongs of fork to [outside ear pinna]--\> where _***A****ir**conduction**is 100x more sensitive** than bone*_ 3rd: Pt should still hear sound for 15 more seconds. If pt can't hear sound for that long = air conduction deafness on that side B: Differentiates between [**Air** and **SensoriNeural: 2nd step**] defects

Answer 45

A: WEBER'S TEST 1st: Tuning Fork placed on Skull midline 2nd: Normally sound is conducted simultaneously by both [ossicular air] and [bone] routes which are out of phase w/each other (1vibration up and 1vibration dwn) 3rd: Being out of phase---\>Cancel each other out on both sides of head--\>sound perceived as coming from midline 4th: If [ossicular air] route loses conduction, cancellation effect on tested ear is DEC and net vibration will be GREATER on the AFFECTED SIDE * can also be caused by [CTL Ear has SensoriNeural defect]* B: Differentiates between [**Air** and **SensoriNeural** **defect: 1st step**]

Answer 46

1st: HA / vomiting / blurred vision 2nd: Coma / Seizures / Cardiopulm arrest (*Amnesia / Parkinsonism*) B: [Hyperbaric O2 chamber] C: [Cocaine (most common) / Amphetamine / PCP / LSD]--\> *vasoconstriction or abrupt HTN--\>cerebral infarct/hemorrhage*

Answer 47

1. [**Early Hypersympathetic Stage**] = tremors + sweaty + tachycardia + [limited convulsive *Tonic--\>Clonic* seizures] tht occur 12 hrs-3 days post drinking] 2. [**Later (*3-4 days post drinking*) Delirium Tremen Stage**] = [Fluctuating motor/autonomic activity] + confusion + hallucinations(visual and auditory) B: Coexisting infectio vs. Trauma C: If pt has [Partial / Focal Seizure] this suggest focal lesion

Answer 48

A: - EtOH itself - Malnutrition from EtOH - Vitamin (*B1*) Deficiencies from EtOh B: [Subdural vs. Cerebral Hemorrhage] C: 1. [Wernicke Encephalopathy] ---\> [Korsakoff Psychosis] 2. [Alcoholic (ANT SUP Cerebellar vermis) Degeneration] 3. Peripheral Neuropathy 4. Dementia

Answer 49

A: **[Wernicke Encephalopathy]** - [Nystagmus vs. Ophthalmoplegia vs. (Gait ataxia) vs. Confusion] - Tx = *Thiamine* *B1 supplement* B: **[Korsakoff Psychosis] = CHRONIC PHASE!** -Amnesia compensated with Comnfabulation

Answer 50

A: Brain uses **Aerobic** metabolism intaking [20% Cardiac Output] and [15% O2 consumption]. ## Footnote *Brain has NO O2 reserve = SENSITIVE TO ISCHEMIA* B: Post cerebral ischemia --\> [Normal for 8-10 seconds] --\> [**Irreversible Damage** **AFTER** **6-8 minutes!**] C: Neurons \> Oligodendrocytes \> [Endothelial Cells] \> Astrocytes D: 1. Cerebellar Purkinje 2. [(**SHC-S**ommer's **H**ippocampus **C**A1) Pyramidal neurons (*long term memory*)] 3. [Cortex Watershed Layers 3 & 5] Pyramidal neurons (***--\>Laminar Necrosis if pt survives Global ischemia longer than 3 days***)

Answer 51

A: **Intracranial Hemorrhage** makes up 15% of causes of Stroke (*Cerebral Ischemia is most common*) - Intraparenchymal Hemorrhage (HTN vs. amyloid) - SubArachnoid Hemorrhage (Saccular Aneurysms vs. AVM)

Answer 52

A: - [**Red Dead Neurons**] (*neuronal cytoplasm appears red because necrosis attracts eosinophilia*) - DEC Nissl substance - Dark Pyknotic nuclei B: [6-12 hours post insult]

Answer 53

**Laminar Necrosis** of [Cortex Watershed Layers 3 & 5] Pyramidal neurons ----\>Laminar Necrosis if pt survives *Global* ischemia longer than 3 days B: Wedge-shaped areas of hyperemia and softening (*particularly in ACA and MCA Watershed Zones*)

Answer 54

A: Ischemic Stroke --\> **Focal** neuro deficits (*In-Situ* *Thrombotic vs. Embolic*) A2: Thrombotic= [Bifurcation of Internal Carotid and MCA] B: [_Small Vessel_ SubCortical infarct] occurs from [***In-Situ Thrombosis***] (Large Vessel Dz can be Thrombosis or embolism): * lenticulostriate vessels perfuse [**B**e **TIPC**]* 1) **Lacunar Stroke**= ischemia of lenticulostriate vessels --\> [cystic infarcts \< 1.5 cm (*mostly seen with* *MRI*)] --\> Lacunar Syndrome (listed below) 1A: [*I*nternal Capsule/*P*ons/*C*orona Radiata] Stroke--\> pure Motor stroke (*ataxia vs. hemiplegia vs. clumsy hand*) 1B: *T*halamu**S** Stroke --\> pure **S**ensory stroke 1C: *B*asal Ganglia - not included in Syndrome *Note: Lacunar lesions may be WITHOUT sx*

Answer 55

A: MRI Brain: Ischemic hemispheric infarct of the [MCA territory] --\> Midline shift B: 1) CTL [Hemiparesis / Hemisensory loss/ Visual field deficits] affecting lower face and UE \> leg 2) Hemisphere infarct will be associated with [**CTL** **expressive aphasia]** 3) [Non-involved hemisphere *ipsilateral* **neglect syndrome**]

Answer 56

A: [Time after insult (*acute vs. subacute vs. remote*)] and [Embolic(**red**) vs. Thrombotic(**pale**)] B: *Brain* *Image on L* 1) Swelling / softening / pallor of brain parenchyma 2) Indistinct border 3) Blurring of Cortex/DEC **White** matter differentiation C: **SUB**Acute Ischemic Infarct = [More Distinct Borders] + [Tissue Liquification] + [Early PMN & Late macrophages/vascular proliferation]

Answer 57

**Remote MCA Infarct** (*will have _cystic spaces_*)

Answer 58

**Embolic Infarct** ## Footnote 1) [Usually smaller & centered at gray-white jxn] 2) Can be single or multiple 3) May involve more than 1 vascular territory C: **MCA** D: Can occlude *Large* Artery at origin OR [occlude *Large* Artery and then **embolize** to [*Distal Large A.*]

Answer 59

**Lacunar Infarct** ## Footnote B: small (*no more than 1.5 cm*) and cystic C: **B**e **TIPC** [(**B**asal Ganglia) /**T**halamus / **I**nternal Capsule/ **P**ons / **C**orona Radiata which all = SubCortical *White* Matter)] D: 1) HTN (*Arterial Hyalinosis*) 2) [small vessel dz]

Answer 60

A: **Hemorrhagic** _Infarctions_ are usually *Embolic* in nature ***Intracranial hemorrhage*** B: **Above** Arachnoid: Traumatic causes (*Epidural and SubDural Hematomas*) C: **BELOW** Arachnoid: Cerebrovascular Dz is cause - **S**ub**A**rachnoid **H**emorrhage (*usually from Aneurysms*) - Parenchymal Hemorrhage (*usually from HTN*)

Answer 61

A: 1. Putamen 2. Thalamus 3. Pons 3. Cerebellum B: [**Charcot Bouchard**]: 1. Lenticulostriate arteries 2. Paramedial pontine vessels 3. Short circumferential vessels of Cerebellum & white matter * similar distribution as lacunar infarcts. Histo with minimal tissue necrosis but does have cystic spaces containing macrophage-laden hemosiderin*

Answer 62

A: 6 - 48 hours B: [pale, soft , swollen] + [**in**distinct border/blurred grey-white junction] C: 1. 6-48 hours= [**Dead Red Neurons**] + Pallor Edema 2. 1-3 Days= Neutrophil infiltration + Necrosis

Answer 63

A: [2 days - 3 Weeks] B: Gelatinous / Friable / **Distinct** Border / [Tissue liquefaction] / [Glial Scar ( *\>2 weeks*)] C: [early neutrophils]--\> [macrophages in 3-5 days] ---\> [vascular proliferation & reactive gliosis in 1-2 weeks]

Answer 64

A: [\> 3 Weeks] B: Cystic / [+/- Hemosiderin staining] / [2° Degeneration] C: - [Astrocytic Gliosis] - [Residual Macrophages]

Answer 65

"[**A**n**_T_**i **AA**] led me straight to the **SAH**" A: - **A**neurysm (*Berry Saccular Aneurysm*) = COMMON *NON-TRAUMATIC* CAUSE - **T**rauma = MOST COMMON ***OVERALL*** CAUSE - **A**VM - **A**nticoagulation B: CSF with xanthochromia (*yellow hue from bilirubin*) C: "Berry-like" thin-walled (*no media*) outpouchings from arterial branch points --\> Rupture at the dome --\> Global Vascular spasm --\> Global cerebral ischemia D: Outpouching of [Circle of Willis: **ANT *Communicating* Artery**] 2º to [Tunica media congenital defect]---\> Rupture at the dome --\> **S**ub**A**rachnoid **H**emorrhage = 50% Fatality within first 24 hours, but **most are asx until rupture** - [Auto Dom Polycystic Kidney Dz] - [Ehlers-Danlos] - Marfans

Answer 66

A: Premature Infants (*RARE IN ADULTS*) B: **Germinal Matrix** beneath ependyma(*easily ruptures into ventricles*)

Answer 67

A: _Herniated [**TUMTL**-*Transtentorial Uncal Medial Temporal lobe*]_ from various mass lesions (*hemorrhage/neoplasm*) --\> 1. **Pons Compression** 2. Perforating Arteriole stretching --\> ischemia

Answer 68

**Epidural Hematoma** ## Footnote B: [Temporal Bone Fracture] --\> [**Middle Meningeal Artery** rupture]--\> [Football/Lens shaped lesion from blood between dura & skull] C: Pt may be lucid b4 any neuo signs manifest *but* Herniation is lethal complication

Answer 69

**Subdural Hematoma** ## Footnote B: [Truama vs. Age] -\> [Tearing of bridge veins between Dura & Arachnoid] --\> [*Crescent* shaped lesion] C: Progressive neuro signs but Herniation is lethal complication D: Elderly (*A**ge-related cerebral atrophy stretches bridging veins*)

Answer 70

A: [Cerebellar tonsils] --*herniates into*--\> [Foramen magnum]--\> Brainstem compression --\> Cardiopulm arrest! B: [Cingulate Gyrus] --*herniates into*--\> [Falx Cerebri]--\> [**ACA** compression] --\> infarct

Answer 71

[**TUMTL**-*Transtentorial Uncal Medial Temporal lobe*] --*herniates under*--\> [Tentorium Cerebelli]--\> Compression of [**POP- *P****CA / **O**culomotor CN3 / **P**aramedian Pontine vessels*] --\> 1. [Occipital lobe infarct from **PCA** compression] ( ---\>*CTL homonymous hemianopsia w/Macular/fovea sparing*) 2. ["Down and Out" Eye + Dilated Pupil] 3. **Duret Hemorrhage** (*with Pons compression*) C: **{**letter **C****}**=**Duret Hemorrhage**

Answer 72

A- [**Middle Cerebral Artery** Infarct] B1 - **Subfalcine** Herniation B2 - [**TUMTL**-*Transtentorial Uncal Medial Temporal Lobe*] Herniation C - **Duret Hemorrhage** (*comes from* **TUMTL** Herniation)

Answer 73

A: [Pt reads at 20 feet] what a [normal person would read at 100 feet] in that eye B: Visual problem may be **neurological** C: Optic Nerve is **Medial**. So [R = [Optic Disc w/ Optic N.]] vs. [L = Macula]

Answer 74

A: Normal Blind spot that occurs due to **Optic disc having no rods/cones** (*center of vision*). This ENLARGES with papilledema from INC ICP B: **Pathological** Blindspot (AKA **SCOTOMA**) occurs from [Ocular/Retinal/Optic N.] Disorder. Usually in 1 eye. C: - If Pt Visual Field enlarges once you move target away from them = [Glaucoma/Retinal Degeneration] - If Pt Visual Field _continues_ to be *Constricted* even as you move target away from them = [Psychogenic Tunnel Vision]

Answer 75

A: Heteronymous (*Bilateral*) **Nasal** Hemianopsia ## Footnote B: 1. Cortical Blindness from Bilateral Occipital lobe infarct vs. 2. [CTL homonymous hemianopsia w/Macular/fovea sparing] from Unilateral Occipital lobe infarct B2: Normal [Pupillary light reflex] & [No Optic Atrophy]

Answer 76

Nystagmus are OSCILLATING EYE MOVEMENTS that have both slow and Fast components (*but test refers to Fast component only)* B1.[**IPNB- I**nduced **P**ostrotatory **N**ystagmus of **B**arany] = Rotation of Head by 45º (*Dix-Hallpike maneuver*) sets endolymph of [**Post semicircular canal**] in motion---\>causes deflection of stereocilia hair cells. B2: If Nystagmus occurs after this = overly sensitive [**Post semicircular canal**] on the side being lowered. = Positional Vertigo

Answer 77

Nystagmus are OSCILLATING EYE MOVEMENTS that have both slow and Fast components (*but test refers to Fast component only)* . B1. **[Induced CALORIC Nystagmus]** is when irrigation of [External Auditory Canal] with Cold/Warm water creates convection currents in *Vestibular labyrinths*---\>stimulates [crista ampullaris] by deflecting stereocilia B2: **COWS** (*ENG-Electronystagmogram*)= * *C**old Water---\>Eyes move **O**pposite direction of irrigation * *W**arm water --\>eyes move in **S**ame direction of irrigation C: test function of individual semicircular canals (_ESPECIALLY LATERAL CANAL_) & [Brainstem normality]

Answer 78

A:[Ischemic infarct] 2º to [Cerebral a. occlusion] can be circumvented if competent [Circle of Willis] collateral circulation detours inadequate blood flow. B: Example: *If Internal Carotid becomes occluded....Collaterals =* 1) **Basilar a.** (*via PCA and PICA*) 2) [**Ipsilateral** **External Carotid a.**] (***retrogradely from ophthalmic a.)*** perfusing [Intracranial Internal Carotid A.] 3) [**CTL** **Internal Carotid a.**] (*via ACA and AICA*)

Answer 79

A: **Reversible** **Stroke with sx** that resolve in a [**_less than_ 24 hour period (usually 10-20 min.)**] = 3rd leading Cause of Death in Developed countries! B: Embolus (*fibrin vs. platelets vs. cholesterol*) C: - [**Amaurosis Fugax monocular blindness**] (*lowered dark shade*) - Hemispheric syndromes (*aphasia & hemiparesis*) D: - [Brainstem vs. Cerebellar] ataxia & diplopia - Homonymous Hemianopsia

Answer 80

*(TIA vs. [Cortical Large Artery Ischemic Infarction]**)* A1: 1st Choice: [Brain **MRI**] = confirms suspected vascular territory involved if infarct occurred 2nd Choice: CT A2: [Carotid US vs. MR/CT/Catheter Angiogram] A3: Echocardiograph B: Also Determine sources of emboli and other infarct causes C:[Atypical tumor] vs. Hemorrhage vs. Abscess vs. Encephalitis

Answer 81

A: Multiple **Lacunar Infarcts** B: **Lacunar Stroke**= ischemia of lenticulostriate vessels --\> [cystic infarcts \< 1.5 cm (*mostly seen with MRI*)] --\> Lacunar Syndrome C: Lacunar Syndrome: * lenticulostriate vessels perfuse [**B**e **TIPC**]* 1) Lacunar Stroke= ischemia of lenticulostriate vessels --\> [cystic infarcts \< 1.5 cm (mostly seen with MRI)] --\> Lacunar Syndrome (listed below) 1A: [**I**nternal Capsule/**P**ons/**C**orona Radiata] Stroke--\> pure _Motor_ stroke *(ataxia vs. hemiplegia vs. clumsy hand)* 1B: **T**halamuS Stroke --\> pure Sensory stroke 1C: Basal Ganglia - not included in Syndrome *Note: Lacunar lesions may be WITHOUT sx*

Answer 82

A: Thrombolytic Drugs (*tPA*) 1. [IV tPA _within 3 hours of stroke_ onset] 2. [intra**A**rterial tPA] to break up clot in stroke center B: Antiplatelet drugs (*or anticoagulant drugs in RARE situations*) C: - Control BP!! - Control Hyperglycemia - Control other complication (*edema / sepsis*)

Answer 83

A: Heparin vs. Warfarin = **Anti**_C_**oagulants** B: [ASA vs. Clopidogrel vs. Dipyridamole] = **AntiPlatelets** C: - Control Atherosclerosis - Carotid Endarterectomy (*only for **symptomatic**-flow limiting [NON-Cranial Internal Carotid A.] with 70-99% Stenosis*)

Answer 84

*High arterial pressure --\>blood rupture into brain* ## Footnote A: "Can't hear yo **C**_H_**ATTA**, if I'm Bleeding in Ma Brain!" 1) [**H**TN-Uncontrolled] = MOST COMMON (*can also be from illicit drugs*). Affects basal ganglia & thalamus most commonly 2) **T**rauma 3) [**C**oagulopathy DEC] (*usually accompanied with systemic bleeding*) 4) [**A**VM rupture]-*Use angiography to visualize* 5) [**T**umor vs. Ischemic Infarct] 6) [**A**myloid Angiopathy in Elderly] B: [_Early_ impairment of consciousness] is **not** usually associated with infarct. + HA + [INC ICP/edema --\> potential local ischemia] C: **CT Scan** (*since it'll show location & severity*)

Answer 85

[Lateral Geniculate nc.] "**L** for **L**ight! " A: Aff= Optic Tract & [SUP colliculus] --\> nc B: Eff= nc---\> [Area 17 CPVC] C: [Specific Relay nuclei]

Answer 86

[medial Geniculate nc.] "**M** for **M**usic" A: Aff= [inf colliculus] --\> nc B: Eff= nc---\> Primary Auditory Cortex C: [Specific Relay nuclei]

Answer 87

A: Lower Motor Neurons are Motor neurons of the Brainstem & Spinal Cord. They are arranged into 4 columns and release ACETYLCHOLINE onto nicotinic receptors of target m. Lower Motor Neurons are recruited based on size & Force B: 4 Column Arrangement: 1. medial LMN--\>axial trunk m. 2. Lateral LMN---\>Distal Limb m. (extremities) 3. Dorsal LMN---\>FLEXORS 4. venTral LMN-------\>exTensors

Answer 88

A: Cells of Origin for [Area 4 precentral gyrus] = [**Pyramidal Betz Cells**] *So...Corticospinal Tract is AKA Pyramidal Tract* B: CST starts in [Area 4 precentral gyrus]---\>forms [CORONA RADIATA]---\>travels in [**Posterior limb**: Internal Capsule]----\> [Crus Cerebri Cerebral Peduncle] ---\>[Base of the Pontine Gray] -----\> **decusates in medullary pyramid**---(travels in)--\>[Lateral funiculus] as the [Lateral CST]---\> synapse on [ANT horn cells] C1: 10% of CST fibers DON'T CROSS AT [medullary pyramids= [ANT CST] . C2:[ANT CST] crosses over at diff levels of [Ventral Funiculus] to still synapse on contralateral [ANT horn cells] like the [Lateral CST] D: **CST Fibers are Upper Motor Neurons** and is the LARGEST Descending Tract E: CST is used for [**Fine motor movements**] like piano playing/picking up pennies

Answer 89

A: Corticospinal Tract has MULTIPLE origins and terminations and consist of ~1 million fibers. 50% of it comes from Primary motor cortex while other 50% comes from areas [Adjacent Frontal motor and Parietal areas] B: The CST projects to [Brainstem & Spinal Cord]. Its collaterals (*both direct & indirect*) travel to basal ganglia, thalamus, [reticular formation of midbrain] and sensory nuclei C: CST Passes through **POSTERIOR limb of Internal Capsule**

Answer 90

A: Sleep like [un**a**rousable *(not **a**lert/**a**wake even after pain)* vs. unresponsive] state where cortex is not functioning B: 1. **Reversible** (*only if treated in time and after a reversible cause*) 2. **Minimal Return** = [Days-weeks post cerebral anoxia] pt may appear awake + [roving eyes] + [pain response] **but still no real interaction** = *Persistent* *Vegetative State* 3. [**Irreversible Brain Death**]: - *mostly from progressive edema & neuron death and can be declared even with heart beat* * -Dx at least 6 hour observation of no imprvmnt + Absent Cerebral blood flow over 10 min on brain scan*) - (Caveot: Muscle reflexes & Babinski can be present in Coma Dx)

Answer 91

A: [Ascending Reticular Activating System] or **ARAS** plays a role in level of alertness, [sleep-wake] rhythms & "Startle" rxns. It helps to Activate the Cerebral Cortex. B: Other "candidates" for activating Cerebral Cortex... 1. Basal forebrain---\>[Basal nucleus of Meynert]----\>ACH 2. [Orexin of LAT Hypothalamus]----\>tuberomammillary body and STABILIZES WAKE STATE 3. Cholinergic neurons near [locus ceruleus] C: Motor Cortex, influences alertness and allows focusing of attention

Answer 92

A: Orexin comes from the [Lateral Hypothalamus] and is responsible for STABILIZING WAKE STATE. It makes sure REM/Non-REM states are TURNED OFF! B: Narcolepsy occurs when pt randomly falls asleep and IMMEDIATELY enters REM Sleep. B2: w/ Cataplexy: sudden episode of REM-like muscle Weakness but during FULL CONSCIOUS AWAKEFULLNESS C: Cataplexy is caused by Autoimmune dz: Body destroying Orexin Neurons D: LATERAL Hypothalamus was previously considered the FEEDING or PLEASURE center

Answer 93

1. [Upper Brain Stem lesions that interupt (**ARAS**-***A****scending **R**eticular **A**ctivating **S**ystem*] 2. [Bilateral Extensive Cerebral Cortex Damage] a: Unilateral Cerebral lesion --\> Edema which affects CTL hemisphere vs. herniation compresses **ARAS** b: Toxic changes (*Drugs vs. anoxia*) --\> **DIFFUSE DAMAGE**

Answer 94

A: Examine [Brain Stem Reflexes] (_**ME** then **PB**_ = ***M**otor vs. **B**reathing vs. **P**upils vs. **E**ye mvmnt*) ***Motor** testing* 1. Withdrawal to pain = some cortical function 2. [**DecorTicate** posturing (*UE Flexion & LE Extension*)] = Cerebral Hemisphere damage 3. [**Decerebrate** posture (*ALL EXTREMITIY EXTENSION*)] = [Midbrain *Red Nucleus* lesion] 4. [Myoclonic jerks & Asterixis] = [Toxic metabolic coma] 5. [Spontaneous Nystagmus & Twitching] = [Coma 2° to *electrical status epilepticus*]

Answer 95

A: Examine [Brain Stem Reflexes] (_**ME** then **PB**_ = ***M**otor vs. **B**reathing vs. **P**upils vs. **E**ye mvmnt*) ***Eye Movement** testing = Both Test indicate _Normal_* *Brain Stem* 1. [Oculocephalic Doll's Eyes Reflex] = eyes conjugately move in direction opposite from head rotation (*normal brain stem response*) - **RULE OUT CERVICAL SPINE FRACTURE BEFORE DOING THIS** 2. [**Induced CALORIC Nystagmus**] is when irrigation of [External Auditory Canal] with *Cold/Warm water* creates convection currents in Vestibular labyrinths---\>stimulates [crista ampullaris] by deflecting stereocilia * **COWS** (ENG-Electronystagmogram)= * *C**old Water---\>Eyes move **O**pposite direction of irrigation * *W**arm water --\>eyes move in **S**ame direction of irrigation*

Answer 96

A: Examine [Brain Stem Reflexes] (_**ME** then **PB**_ = ***M**otor vs. **B**reathing vs. **P**upils vs. **E**ye mvmnt*) ***Pupils** testing* 1. Pupil Dilation (*hypothalamus--\>brain stem--\>spinal cord--\> **sympathetic** ganglia*) 2. Pupil Constriction (*Oculomotor CN3 & Parasympathetics*) 3. Pupillary Light Reflex (**Doesn't rule out Metabolic Coma**) 4. Small Pupils ([*Narcotics/Glaucoma Cholinergic Eyedrops*] vs. [*Normal in Awake Elderly*] 5. [Unilateral Large Pupil] (*possible Oculomotor CN3 compression from uncal herniation*) = **EMERGENCY!!!**

Answer 97

A: Examine [Brain Stem Reflexes] (_**ME** then **PB**_ = ***M**otor vs. **B**reathing vs. **P**upils vs. **E**ye mvmnt*) ***Breathing** testing* 1. **Cheyne-Stokes** = *alternating* tachypnea & apnea from bilateral cortical lesions vs. HF vs. sleeping elderly 2. **Hyperventilation** = mostly from pulmonary congestion 3. [**Irregular Ataxic**] = Lesion at/near [medullary cardiopulmonary control] --\> impending respiratory failure

Answer 98

1st: **ABC** = **A**irway / **B**reathing / **C**irculation 2nd: Check Blood-glucose --\> Give [50% IV Dextrose] if necessary 3rd: W/u for Toxi-metabolic coma (*don't forget CO poisoning and hypOthermia*) - Myoclonic Jerks & Asterixis 4th: W/u for **Structural** Coma (*hemorrhage / tumor / infarct*) = hemispheric abnormalities

Answer 99

*Pt is Arousable but not really **responsive*** ## Footnote A: [Days-weeks post **Cerebral Cortex** anoxia] pt may appear awake + [roving eyes] + [pain response] **but still no real responsiveness** = *Persistent* *Vegetative State* B: Some CN reflexes may still be intact (*Brainstem & Spinal Cord are still intact*) C: Brainstem & Spinal Cord D: Coma --\> Minimal Return

Answer 100

A: Pt who is progressively becoming [unaware of problems] and [unable to understand/communicate], typically associated w/behavioral changes B: Establish Directives early! (*since* *family will eventually assume all decision-making*) C: [Olfactory Dysfunction] --\> No Appetite, but pt will still have "basic need" to hydrate. Tx= [**PEG**-**P**ercutaneous **E**ndoscopic **G**astrostomy] vs. feeding tube

Answer 101

A: The SCN [Suprachiasmatic Nucleus] is located Above Optic Chiasm and is used as our endogenous "biological clock" & CIRCADIAN Pacemaker. It keeps us on a 24 hour cycle, turning some systems on/off. This is a nucleus of the HYPOTHALAMUS. B: Light (reason its near Optic Chiasm), Food & Temperature C: Sleep-Wake ------------------------------------------------------------------------------ D: Biologic Rhythms by the SCN are not linked exclusively to the HIPPOCAMPUS. It works together with Environmental Cues. These are the 4 Categories: 1. Ultradian = less than 24 hours --\>Resp/HR 2. Circadian = 24 hours ---\>Corticosterone rhythm 3. Infradian = More than 24 but less than 1 year--\>menstrual cycles 4. Circannual= every year---\> Hibernation -------------------------------------------------------------------------------------- E: Highest amount of SCN hormone secretion = When ur Sleep

Answer 102

A: Disconnection syndromes usually result from WHITE matter damage interfering with Corpus Callosum or ANT commissure. B: 1. Alexia = impaired reading (*visual cortex is disconnected from language center*) 2. Agraphia= impaired writing (*motor cortex for dominant hand is disconnected from language center*) 3: [*NON-Dominant* Hemisphere lesions] in the [mirror image locations of **cortical language center**]--\> **Aprosody** (*inability to interpret the [**TIP**-**T**one/**I**nflection**/P**itch] of language*) C: [Alexia ***without*** Agraphia] is usually caused by PCA stroke to Occipital Lobe. Corpus Callosum of this area is affected---\>Seeing object in L eye CAN'T be interpreted in the R brain like normal.

Answer 103

A: Lesion of [**SubThalamic Nucleus**] --\> less Stimulation of [**Globus Pallidus: *internal*]** --\> **HYPER**Kinesia (*specifically* *VIOLENT limb flinging*) B: Hunt**I**ngton's = [Auto Dominant Degeneration of ((**_I)_ndirect** Striatum) 2° to [Chromo 4 trinucleotide repeats]] "*Hunter was way too excited*" C: Parkinson's = [Degeneration of (**Substantia Nigra:*Compact*)** = Loss of All Dopamine] ***DDEM** = **D**opamine & [**D**irect Path] **E**nable **M**ovement*

Answer 104

A: A: [Chorea and Dystonia] are SE of **Dopamine** **AGONIST** B: 1. Essential Tremor 2. [Myoclonus vs. Asterixis (*ToxiM**etabolic etiology*)] 3. Dystonia 4. Tic C: [Caudate / Putamen / [Globus Pallidus] / [Substantia Nigra] / [SubThalamic Nucleus]]

Answer 105

A: **PARK** & **ham** 1. [**P**ill Rolling Resting Tremor] 2. [**R**igidity Cogwheel] 3. Brady**K**inesia 4. [**A**Reflexia posturally] --\> Fall B: - **h**ypOphonic speech - **A**utonomic Dysfunction (*constipation / bladder problems / orthostatic hypOtension*) - **m**icrographia

Answer 106

A: 1) Parkinson's Dz 2) [Rare Degenerative Disorders (*progressive supranuclear palsy vs. multiple system atrophy*)= **NOT responsive to levodopa** 3) [Dopamine Blocker (*Haloperidol*) **SIDE EFFECTS**] 4) [Manganese vs. Carbon Monoxide Poisoning] B: onset between 40-70 y/o C: [2 or more *Primary* Clinical Signs --- typically worst on 1 side and progressive] + [Responds to **Dopaminergic** tx] D: *Lewy Bodies* = [alpha synuclein cytoplasmic accumulations tht are eosinophilic]

Answer 107

"Eat a **SALAD** after you Park" 1. [**Levodopa** (*Dopamine Precursor*)] 2. **Amantidine** (*_weakly_* *stimulates Dopamine release*) 3. **Anticholinergics** (WEAK effect) 4. [**Dopamine Agonist** *Post synaptic*] (*Ropinirole vs. Pramipexole*): Also has ability to [DEC Long term Dyskinesia if given as monotherapy] 5. **Surgical tx** - Used in Pts refractory to meds - Pallidotomy: Intential Destructive Lesion of the [**Globus Pallidus:*internal***] - SubThalamic nuc. _inhibition_ with implanted electrode

Answer 108

**Levodopa** = **Parkinson's Dz** tx ## Footnote A: Administered with **Carbidopa** (*decarboxylase inhibitor*), which prevents peripheral **Levodopa** catabolism before it has chance to enter brain B: DEC over time since there will continue to be dopaminergic neuron death. [MAO-B and COMT-_inhibitors_] sustain effective **Levodopa** levels C: [Hallucinations vs. Psychosis vs. Chorea vs. DysTonia]

Answer 109

**Lewy Body Dementia** is the **SECOND** common type of neurodegenerative dementia B: [Dementia + Visual Hallucinations] --\> [**Parkinsonian** sx] C: [alpha synuclein cytoplasmic accumulations tht are eosinophilic] - found in Cortex & Brainstem

Answer 110

A:[**Frontotemporal Degeneration**] is the THIRD common type of neurodegenerative dementia *BUT MAY BE CONCOMITANT WITH ALZHEIMER'S*. Typically worst on Left. B: Change in personal/social conduct, associated with **disinhibition** and **language changes** C: [Chromo 17 **Tau** gene mutation] D: *Immunohistochemistry* against: [Tau vs. Ubiquitin vs. TDP43]

Answer 111

A: *RARE* *SubType* of [**Frontotemporal Dementia**] B: **Aphasia** (*minimal memory loss but may develop Dementia*) C: **Pick Bodies =** _Globose_ neuronal cytoplasmic inclusions made of **Tau**. D: Hippocamps and Cortex

Answer 112

A: Hunt**I**ngton's = [Auto Dominant Degeneration of ((**I**)ndirect Striatum) 2° to [Chromo 4 trinucleotide repeats]] "*Hunter was way too excited*" B: [Degeneration of Caudate nc.] --\> [DEC GABA and ACh] C: [NMDA-R binding and Glutamate]

Answer 113

A: 40-60 (*Parkinson's Dz Onset = 40-70*) B: *Atrophy of **COPS*** 1. Parkinsonism -***S**ubstantia nigra atrophy* 2. Cerebellar Ataxia - ***C**erebellar atrophy* 3. Autonomic dysfunction -[***O**livary nc./**P**ons atrophy*] C: [**GLIAL** **alpha synuclein** cytoplasmic accumulations tht's eosinophilic]

Answer 114

[Friedrei**CH'S** Ataxia] ## Footnote A: Most common **Hereditary Ataxia** B: [Auto **r**ecessive *GAA Trinucleotide repeat* in Chromo 9 Frataxin gene] *Frataxin is needed for mitochondrial iron* C: [Friedrei**CH'S** Ataxia] 1. [**C**erebellar Degeneration]--\> Ataxia 2. **H**eart Abnormalities --\> 50% of deaths! 3. [**S**pinal Cord Degeneration] --\> [Loss of **2TVP**] + [Muscle Weakness] + [Loss of Deep Tendon Reflex]

Answer 115

A: **Mixed Dementia** mostly consist of **Alzheimer's** & [**Vascular Dementia**] ## Footnote B: 1) [*ApoE4 genotype*] INC risk of Alzheimer's AND CV Dz 2) *Vascular Amyloidosis* INC risk of hemorrhagic strokes --\> [Vascular Dementia] C: CADASIL = involves small arterioles & capillaries

Answer 116

**TACO** ## Footnote A: **_T_**hiamine deficiency ---\> 1. **_O_**culomotor abnormalities (*ophthalmoplegia vs. nystagmus*) 2. **_C_**erebellar Dysfunction 3. **_A_**ltered Mental Status B: [+/- Korsakoff Psychosis from **mammillary body hemorrhage & atrophy** (*can't recall recent memory so compensates with confabulation*)] C: ****_T_**hiamine** Deficiency

Answer 117

A: **ETHANOL TOXICITY** ## Footnote B: Triangular lesion with myelin loss of the *Pons* C: [Rapid Correction of Chronic hypOnatremia]

Answer 118

A: Hepatic oxidation of [Methanol --\> (Formaldehyde & Formic Acid)]--\> - global hypoxia - *white matter* necrosis & hemorrhage--\> [Putamen & Claustrum hemorrhagic infarct] B: [Vision loss vs. Delirium/Convulsions vs. Coma vs. Death]

Answer 119

1. [**Bilateral** **Globus Pallidus** Hemorrhagic Necrosis] 2. [*White* Matter Hemorrhagic Petechiae] 3. Cerebral Edema

Answer 120

A: [Alzheimer Type 2 Astrocyte] = [Nuclei are large and appear clear] B: liver Failure--\> Hyperammonemia (*Hepatic Encephalopathy*)

Answer 121

A: Speech = **Phonation** and **Articulation** - **Phonation**: *making sounds* with vocal cord mvmnt (*Vagus CN10*) - (*Dysphonia = Hoarse vs. whispery*) - **Articulation**: *articulating sounds* with [lips/tongue/palate/pharynx] (*Dysarthria* = *slurred speech 2º to **Articulation** problems*) B: Disorder of [previously acquired language ability] due to [language center lesion in *dominant* hemisphere] --\> **all-around** **impaired** **communication** (*includes gestures & Braille*)

Answer 122

A: [Sylvian Lateral Sulcus] of the dominant *(usually L hemisphere**)* hemisphere B: MCA C: 1) Wernicke's area = language **comprehension** 2) Broca's area = language **execution/expression** D: Imperfect Repetition

Answer 123

[Word or Syllable Substitutions] ## Footnote - Phonemic or literal = *Sully* for *Silly* - [Semantic or verbal]= *blue* for *Green* * -*Neologism= nonsense word: *scatifang*

Answer 124

A: [Area 44 Inferior Frontal Gyrus] + [involvement of adjacent motor cortex] B: - [Poor Repetition/Naming/_Fluency_ ([telegraphic **non**fluency ( *"I.....up.....early"*)]] - R Hemiparesis - Facial Weakness

Answer 125

A: [Temporal Lobe (*posterior vs. superior*)] B: - [Poor Repetition/Naming/_Comprehension_ (*They don't comprehend you and You can't comprehend them*)] - Hemiparesis C: Psychiatric disorders

Answer 126

A: [Arcuate Fasciculus (*tract between Broca & Wernicke*)] B: [**Intermediate** version of *Wernicke**'s* *Aphasia*]

Answer 127

A: [Broca + Wernicke + Arcuate Fasciculus] = ALL! B: [**SEVERELY NONFLUENT / MUTE / poor comprehension**]

Answer 128

A: [Semantic & Emotional meaning] conveyed by the [**TIP**-***T**one/**I**nflection/**P**itch*] of Language B: [**Non**dominant Hemisphere lesions] in the [mirror image locations of cortical language center] C: - [Sensory Receptive Aprosodia] - [***Non****Dominant Wernicke's lesion]* - [Motor Expressive Aprosida] - [***Non****Dominant Broca's lesion]*

Answer 129

A: [**Non**Dominant **Wernicke's** lesion] B: **Speaks with Prosody** but has [Poor prosodic comprehension when listening] and [unable to repeat prosody in others' speech]

Answer 130

A: [**Non**Dominant **Broca's** lesion] B: **DOES NOT SPEAK with Prosody and** **[unable to repeat prosody in others' speech]** but has [Good prosodic comprehension when listening]

Answer 131

A: Pt are only _unable to walk_ when **commanded to** walk, even though they have all the essentials to walk intact B: PARIETAL LOBE LESION --\> pt _unable to draw_ when **commanded to** draw *Apraxia is not due to sensory/motor/language deficit*

Answer 132

A: [**Broad**-**based** Ataxic Gait] B: 1. [Dorsal Column and its associations] or 2. [Cerebellum (*Gait is _constantly_ bad regardless of eyes open/close*)]

Answer 133

A: [**Hemiplegic** Ataxic Gait] B: Stroke *UE: [Upper limb flexed at elbow + DEC armswing] on affected side*

Answer 134

A: [**Stomping foot gait**] where pt forcibly plants feet down on ground to "feel" floor & compesnate for impaired sensation B: 1. [Tabes Dorsalis Neurosyphilis] or 2. [Severe Neuropathy]

Answer 135

A: [**Steppage** Ataxic Gait] B: 1. [peroneal n. lesion] 2. [L5 root lesion] 3. Peripheral Neuropathy to prevent tripping over the toes, the hip is flexed even higher to elevate the drooping foot, which is lowered to the floor toe first

Answer 136

A: [Pelvic vs. Hip muscles] can't support body when on 1 leg so swaying/leaning when foot is raised helps = alternatively wadduling like a duck! B: Myopathy

Answer 137

A: [**Scissors** Ataxic Gait] B: 1. CST lesions--\> [spastic paraparesis]--\>tightness in adductor muscles and knees--\>legs cross over each other like **scissor blades** C: - Cerebral Palsy - Multiple Sclerosis

Answer 138

A: [**Parkinsonian** Ataxic Gait] B: Parkinson's C: [Slow shuffling gait] with *Stooped forward* *posture* and **festination** (leaning more & more forward to walk and then runs to catch up with center of gravity). Falls a lot.

Answer 139

A: Dysarthria = slurred speech 2º to **Articulation problems** B: [Nystagmus with erratic, jerky mvmnt] C: 1. Kinetic Tremor (*rhythmic oscillations during limb mvmnt*) 2. Dysmetria (*overshooting/undershooting target*) 3. Mvmnt Decomposition (*jerky and broken down*) 4. [Rebound Check response Deficit] (*sudden release of contracted triceps from loss of check response from antagonist muscle--\>pt hits himself*)

Answer 140

A1: ***Ipsilateral*** Limb [kinetic tremor/dysmetria/rebound check response loss] A2: Any Bilateral lesion in degenerative dz (*MS*) B1: ***TRUNK*** [truncal unsteadiness with standing / walking / gait ataxia] B2: - Alcoholic Cerebellar Degeneration (*ANT SUP vermis atrophy*) - Any Bilateral lesion in degenerative dz

Answer 141

A: [Friedreich's Ataxia] B: No curative tx and Older pts become wheelchair-dependent *[Cerebellar and Spinal Cord Nc. and tract are affected]*

Answer 142

A: [slow continuing limb movements= **Athetosis**] + [Irregular dancelike movements = **Chorea**] B: Limb, trunk and face C: - [Caudate nc. lesion (*Huntington's Dz*)] - [Dopaminergic medications]

Answer 143

A: Brief repetitive contractions of muscle groups (*facial twitch vs. eye blink vs. sniffs vs. grunts*) B: Tourette's (*inherited with variable penetrance-mostly boys*)

Answer 144

A: Asynchronous rapid shocklike mvmnts of limbs or body bilaterally B: - Diffuse Encephalopathy (*Creutzfeldt Jakob Dz*) - Medical Dz (*Renal/Hepatic Failure vs. Anoxia*)

Answer 145

A: **Flapping Tremor** of hand/foot from [postural tone loss] typically bialterally B: - Diffuse Encephalopathy (*Creutzfeldt Jakob Dz*) - Medical Dz (*Renal/Hepatic Failure vs. Anoxia*) - Structural brain lesions - **will be Unilateral**

Answer 146

A: [Beta blockers vs. Barbiturates] B: [Anticholinergics vs. Benzodiazepines vs. Botox]

Answer 147

[Thalamic RETICULAR nucleus] projects ONLY to other thalamic nuclei and NOT the Cerebral Cortex. Neurons of this nuclei are [inhibitory GABAergic]. B: Thalamic Axons passing thru (both incoming & outgoing) give off collaterals to [Thalamic RETICULAR nucleus]. C: Main Purpose of [Thalamic RETICULAR nucleus] is to inhibit random background sensory activity ---\> Enhances salient activity of 1 area of thalamic neurons.

Answer 148

[ANTERIOR nc.] A: Aff= Mammillary body & Hippocampus ---\> nc B: Eff= nc---\> projects to Cingulate Gyrus C: [Specific Relay nuclei]

Answer 149

[VENTRAL Anterior nc.] A: Aff= Basal ganglia ( [substantia nigra] ) ---\> nc B: Eff= nc---\> projects to PreFrontal Cortex C: [Specific Relay nuclei]

Answer 150

[VENTRAL Lateral nc.]\>ANT part (**VL\>ant**) A: Aff= Basal ganglia ([Globus Pallidus])---\> nc B: Eff= nc---\> projects to Supplementary motor area C: [Specific Relay nuclei]

Answer 151

[VENTRAL Lateral nc.]\>**PoST** part A: Aff= Cerebellum---\> nc B: Eff= nc---\> MOTOR CORTEX C: [Specific Relay nuclei]

Answer 152

[VENTRAL POSTEROMEDIAL nc.] A: (Somatic) Aff= Head --\> nc B: Eff= nc---\> Somatosensory Cortex C: [Specific Relay nuclei] D: Involved with relaying Vestibular information

Answer 153

[VENTRAL POSTEROLateral nc.] A: (Somatic) Aff= [Trunk&Limbs] --\> nc B: Eff= nc---\> Somatosensory Cortex C: [Specific Relay nuclei] D: Involved with relaying Vestibular information

Answer 154

[Lateral Geniculate nc.] A: Aff= Optic Tract & [SUP colliculus] --\> nc B: Eff= nc---\> [Area 17 CPVC] C: [Specific Relay nuclei]

Answer 155

[medial Geniculate nc.] A: Aff= [inf colliculus] --\> nc B: Eff= nc---\> Primary Auditory Cortex C: [Specific Relay nuclei]

Answer 156

[Lateral Dorsal nc.] A: Aff= Hippocampus--\> nc B: Eff= nc---\> Cingulate cortex C: [Specific Relay nuclei]

Answer 157

[(Lateral POST) & Pulvinar nc.] A: Aff= [SUP colliculus]/[Area 17 CPVC]/ [Primary auditory cortex]/Somatosensory Cortex -----\> nc B: Eff= nc---\> {PPLTAC} "Posterior Parietal and Lateral Temporal Association Cortex" C: [Association nuclei]

Answer 158

[Dorsomedial nc.] A: Aff= [Prefrontal Cortex]/Olfactory/Limbic -----\> nc B: Eff= nc---\> PreFrontal Cortex C: [Association nuclei]

Answer 159

[Intralaminar nc.] A: Aff= [Reticular Formation]/[BasalGanglia]/limbic -----\> nc B: Eff= nc---\> Cerebral Cortex/[BasalGanglia]/limbic C: [**Non-Specific nuclei**]

Answer 160

[Thalamic RETICULAR nucleus] A: Aff= Thalamus & Cortex-----\> nc B: Eff= nc---\> ONLY other Thalamus nuclei C: [Non-Specific nuclei] D: Aside from this [Thalamic RETICULAR nucleus], All OTHER thalamic nuclei "decide" where info should go in Cerebral cortex

Answer 161

Intralaminar nc. and [thalamic reticular nuclei] are both types of the NON-SPECIFIC functional group

Answer 162

"*Amnesia* comes from **H**aving **M**emory **T**roubles!" **Bilateral** lesions in: - **T**halamus 2. **M**amillary bodies (*Thiamine deficiency-Wernicke Korsakoff*) 3. **H**ippocampus (*Herpes Encephalitis / Anoxia / Alzheimer's*)

Answer 163

A: Failure to identify Object via 1 sensory modality, but can identify objects via others B: Failure to *visually* recognize a bell but can identify when hearing or touching the bell C: Failure to recognize bell *from touch* but can identify in other ways which also = [Severe Astereognosis]

Answer 164

A: **F**rontal Lobe has **D**&**G** on **D**&**G** 1. [**D**isinhibition / Lack of concern] 2. [**D**istractible motor and mental function (*Poor planning & impaired creatitivity*)] 3. [**F**rontal lobe release signs in *(Normal in infants only*)] 4. [**G**egenhalten Paratonia (*resistance to passive limb mvmnt*)] 5. **G**ait Apraxia

Answer 165

A: Bilateral: 1. Amnesia (hippocampal lesions) 2. [Cortical Deafness from Auditory lesions] 3. [Kluver Bucy Syndrome] B: Dominant Hemisphere lesion: *Wernicke's Aphasia*

Answer 166

A: Impairment of spatial relationships between body and its surroundings - Anosognosia: Unawareness of hemiparesis or denial of an entire half of your body = **Hemispatial Neglect** - Constructional Apraxia: Inability to **write** when commanded to B1: "*Gerstmann's* **HAD** a *Syndrome*" Gerstmann's Syndrome ([**H**and disorientation + Finger agnosia] /**A**graphia / **D**yscalculia -[Supramarginal vs. Angular Gyrus]

Answer 167

A: 1. **Anton's Syndrome**: Denial of Cortical Blindness 2. **Visual Agnosia** 3. **Prosopagnosia**: *Inability to recognize previously known faces* = subtype of Visual Agnosia B: [Dominant TemporOccipital lesion] --\> **Color Anomia** (*inability to name colors*)

Neuropathology 1 Flashcards

(192 cards)