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190 Cards in this Set
- Front
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differentiate the increased tone from spastic UMN weakness from parkinson's cogwheel rigidity
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spastic UMN weakness is velocity dependent unlike cogwheel rigidity which is not
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what is the exception to most muscle diseases having proximal muscle weakness more than distal
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myotonic dystrophy
|
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what is usually elevated in myopathies
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creatine kinase
|
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EMG findings in myopathies
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small motor unit potential - because the muscle fibers in each motor unit are randomly lost resulting in fewer muscle fibers per motor unit
|
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differentiate dermatomyositis and polymyositis
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polymyositis - T cells directed against the muscle fibers
dermatomyositis - complement mediated vasculopathy against the muscle capillaries, associated with a skin rash |
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characteristics of myotinic dystrophy
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autosomal dominant
myotonia wasting of temporal muscle frontal balding conduction abnormalities CTG trinucleotide repeat on chormosome 19 |
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differentiate dermatomyositis and polymyositis
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polymyositis - T cells directed against the muscle fibers
dermatomyositis - complement mediated vasculopathy against the muscle capillaries, associated with a skin rash |
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characteristics of DMD
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x-linked recessive
pseudohypertrophy of calves very high CK levels absent dystrophin deletion or duplication on Xp21 severe proximal leg and pelvic girdle weakness |
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decreased number of ACh receptors available for binding at the NMJ
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myasthenia gravis
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symptoms associated with MG
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ocular - double vision and ptosis
bulbar - dysphagia fatiguing extremity weakness |
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diagnosis of myasthenia gravis
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tensilon test (edrophonium)
elevated AChE receptor antibodies EMG reveals a decremental response |
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what should be checked in a patient with myasthenia gravis
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thymoma
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treatment of myasthenia gravis
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pyridostigmine
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associated with a decreased release of ACh from presynaptic terminal
symptoms |
botulism - nicotinic and muscarinic receptors are affected - rapidly progressive descending paralysis and mydriasis and constipation
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antibody directed against the nicotinic acetylcholine receptor
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myasthenia gravis
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associatd with infant ingestion of honey
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infantile botulism
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EMG reveals an incremental response
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Lambert-Eaton syndrome
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antibodies against the presynaptic voltage gated calcium channels
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Lambert-Eaton
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symptoms associated with Lambert-Eaton
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leg weakness
dry mouth absent reflexes - increase briefly after muscle activation |
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neoplasm associated with Lambert-Eaton
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small cell lung cancer
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cranial nerve associated with lacrimation and salivation
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CN VII
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what nuerotransmitters initiates sweat gland action
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ACh (muscarinic) even though it's a sympathetic response T1-L2
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is the pupil affected in myasthenia gravis
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No, because only nicotinic postganglionic ACh receptors are affected
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TCA associated with atropine-like side effects
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amitriptyline
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it is normal for some elderly individuals to have diminished ankle jerk reflexes
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**
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causes of peripheral neuropathy
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DANG THERAPIST
D - DM A- alcohol N - B12 deficiency G - Guillain-Barre syndrome T - trauma H - hereditary (charcot-marie-tooth) E - endocrine R - rheumatologic A - amyloidosis P - porphyria I - infections S -sarcoidosis T - toxins (phenytoin, INH without B6, arsenic, lead, vincristine) |
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acute inflammatory demyelinating polyradiculoneuropathy
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Guillain-Barre syndrome
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symptoms of Guillain-Barre syndrome
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ascending paralysis
bilateral facial weakness unstable blood pressure no reflexes sensory loss flaccid weakness |
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diagnosis of Guillain-Barre
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high CSF protein
conduction block and slowed conduction velocity by EMG |
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differentiate the cells responsible for remyelination of Guillain-Barre and multiple sclerosis
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GBS - schwann cells
MS - oligodendrocytes |
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where are sodium channels at the highest density in a neuron
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the initial segment and at the node of Ranvier
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how are muscle stretch reflexes initiated
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activation of muscle spindles - monosynaptic reflex
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result of compression of the median nerve across the wrist
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carpal tunnel syndrome
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causes numbness of the hand (digits 1-3) and awakens patients from sleep
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carpal tunnel syndrome
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results in weakness of the hand and numbness of digits 4 and 5
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ulnar neuropathy at the elbow
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differentiate radial neuropathies at the spiral groove or above
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saturday night palsy - at the spiral groove - results in normal tricep function because the nerve has already gone of proximally - both result in a wrist drop
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where does the peroneal nerve get compressed resulting in weak foot dorsiflexion
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fibular head
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3 causes of foot drop
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1. peroneal neuropathy
2. L5 radiculopathy 3. ALS |
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spontaneous discharge of individual muscle fibers
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fibrillations
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spontaneous discharge of individual motor units
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fasciculations
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what results in a large amplitude of MUP
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anything that involves the LMN axons (anterior horn cells, root, plexus, peripeheral nerve) because re-innervation and recruitment of additional motor units
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what results in small MUPs
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myopathies - because there is random, scattered drop out of individual muscle fibers
|
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characteristics of a LMN injury
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fibrillation acutely and later a LARGE motor unit potential
|
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lesions of the nerve roots
symptoms |
radiculopathies:
both motor and sensory symptoms painful shooting pain in the limb and dermatomal distribution |
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which dermatome lies below the C4 dermatoms
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T2
|
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nerve roots associated with the following reflexes:
biceps brachioradialis triceps patellar archilles |
biceps - C5,6
brachioradialis - C5,6 triceps - C7 patellar - L2-4 Achilles - S1,2 |
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most common cervical radiculopathy - presents with neck pain and often radiates into the hand
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C7 radiculopathy
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C5 radiculopathy
weakness sensory reflexes |
weakness - deltoids, infraspinatous, supraspinatous, brachioradialis
sensory - shoulder, lateral arm/forearm reflex- biceps, brachioradialis |
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C7 radiculopathy
weakness sensory reflexes |
weakness - triceps, pronator teres, finger extensors
sensory - palm/digits 2-4 reflex- triceps |
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C8/T1 radiculopathy
weakness sensory reflex |
weakness - hand
sensory - 5th digit, medial forearm reflex - none |
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most common lumbosacral radiculopathy - presents with back pain which radiates down the back of the leg
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S1 radiculopathy
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L2-4 radiculopathy
weakness sensory reflex |
weakness - quadriceps, hip flexors, thigh adductors
sensory - anterior thigh, medial lower leg reflex - patellar |
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L5 radiculopathy
weakness sensory reflex |
weakness - foot drop, foot inversion, knee flexion, hip abduction
sensory - lateral leg, dorsal foot reflex - normal |
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S1 radiculopathy
weakness sensory reflex |
weakness - gastrocnemius, gluteus maximus
sensory - posterior leg, plantar foot reflex - achilles |
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upper trunk lesion
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Erb's palsy (C5,6 nerve roots) - waiter's tip position
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lower trunk lesion
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C8/T1 nerve roots - Klumpke's palsy (hand weakness), thoracic outlet syndrome, pancoast tumor (horner's syndrome)
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lesion of long thoracic nerve
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scapular winging
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meralgia paresthetica
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lateral femoral cutaneous neuropathy - associated with wearing a tight belt and overweight individuals
|
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acute and severe lumber plexopathy with weakness and sensory loss in the lumbar plexus distribution and abdominal pain in a hospitalized post-op patient
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retroperitoneum hemorrhage due to excessive anticoagulation with IV herparin therapy
|
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two main anterior horn cell diseases
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ALS
polio |
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symptoms associated with ALS
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UMN - corticospinal and corticobulbar tract degeneration - pseudobulbar palsy
LMN - anterior horn cell degeneration and brain stem motor nuclei (nucleus ambiguus and hypoglossal nucleus) - bulbar palsy fasciculations |
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viral disease associated with fasciculations, normal sensation, absent reflexes in affected area
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polio virus
|
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corticospinal tract
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precentral gyrus - corona radiata - posterior limb of the internal capsule - cerebral peduncle - basis pontis - medullary pyramid - pyramidal decussation - lateral spinal cord
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common features of spinal cord lesions (myelopathy)
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UMN findings blow the level of lesion
LMN findings seen at the level of the lesion |
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Brown-Sequard syndrome
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ipsilateral spastic motor deficits
ipsilateral dorsal column deficits contralateral pain and temperature deficits |
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what is spared in a central spinal cord syndrome
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sacral nerves - most lateral in the spinothalamic pathway
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produces bilateral pain and temperature deficits in the arms, usually in the cervical region
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syringomyelia
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anterior spinal artery occlusion
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all function below level of infarction may be lost producing spastic weakness and loss of pain and temperature - posterior column is preserved
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posterior spinal artery occlusion
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pure loss of posterior column function below the level of the lesion - stomping gait
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demyelination of the posterior columns
CST demyelination small fiber peripheral neuropathy |
B12 deficiency
|
|
what is used to detect B12 deficiency
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anemia associated with high MCV
high levels of homocystine and methylmalonic acid |
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motor nucleus for CN IX and X
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nucleus ambiguus
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degeneration of this nucleus in ALS results in bulbar palsy
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Nucleus ambiguus
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lateral medullary syndrome
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occlusion of the vertebral artery or PICA:
STT - contralateral P and T spinothalamic tract - ipsilateral horner's syndrome nucleus ambiguus vestibular nuclei inferior cerebellum |
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nucleus solitarious
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CN VII - taste
CN IX - blood pressure CN X - lungs important for induction of sleep |
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medial medullary syndrome
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contralateral spastic weakness and loss of vibration/proprioception
ipsilateral atrophy of tongue |
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lesion of the lateral vestibular nuclei (midbrain or pons)
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decerebrate posturing
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acoustic schwannoma
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cerebellopontine angle mass
CN VIII - hearing loss, dizzness, tinnitus CN VII and V later resulting in diminished corneal reflex ipsilateral ataxia from compression of the cerebellum |
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3 trigeminal nuclei
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mesencephalic - proprioceptive information
principal - tactile and pressure spinal - pain and temperature |
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corneal reflex
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afferent CN V, efferent is bilateral CN VII
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|
differentiate CN for visceral senation and taste
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visceral - CN V
taste - CN VII |
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UMN lesion of CN VII
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lower facial weakness, but not upper because it has bilateral representation
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LMN lesion of CN VII
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Bell's palsy - upper and lower facial weakness
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caudal RAS
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important for induction of sleep, raphe nucleus, serotonin
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CN III palsy
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eyes is deviated down and laterally
ptosis mydriasis |
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Weber's syndrome
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infarction of the midbrain cerebral peduncle and the 3rd nerve as it travels by
ipsilateral 3rd nerve palsy and contralateral hemiplegia |
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DDX of CN III palsy
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Weber's syndrome
uncal herniation posterior communicating aneurysm DM - ischemic lesion of 3rd nerve cavernous sinus thrombosis |
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CNs involvedin cavernous sinus thrombosis
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CN III, IV, VI, and V1
|
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1st, 2nd, and 3rd order of the sympathetic pathway - lesions of each that can result in Horner's syndrome
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1st - hypothalamus to T1-2 (pontine hemorrhage, PICA stroke)
2nd - T1-2 to superior cerivcal ganglion (pancoast tumor) 3rd - SCG to pupil/blood vessels/sweat glands (carotid dissection, cluster headache) |
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miosis
ptosis anhydrosis |
Horner's syndrome
|
|
a lesion of the optic nerve results in what finding
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afferent pupillary defect
|
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weakness in superior oblique muscle with difficulty looking down and in - patients tilt their head
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trochlear nerve palsy
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3 conditions that restrict vertical eye movements
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thalamic hemorrhages
progressive supranuclear palsy pineal tumor |
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tract important in head turning and localize visual and auditory information
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tectospinal tract
|
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how does the inferior olivary nucleus connect with the cerebellum
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climbing fibers
all of inputs are called mossy fibers |
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the source of the outflow from the cerebellar hemisphers via the VL nucleus of the thalamus to the motor cortex
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dentate
|
|
chronic alcoholism can result in degeneration where
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anterior lobe of the cerebellum - resulting in gait ataxia
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lesion of the central tegmental tract
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palatal myoclonus
|
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mollaret's triangle
|
red nucleus - (central tegmental) -inferior olive - (climbing fibers) - cerebellum - (superior cerebellar peduncle) - red nucleus
|
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which spinocerebellar tract crosses the midline twice
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ventral spinocerebellar tract
|
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source of outflow from the vermis and flocculonocular lobe to the vestibular nuclei
|
fastigial cerebellar nucleus
|
|
important in coordinating proximal muscles
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paravermis
|
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this area coordinates the vestibular system and midline truncal musculature
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vermis
|
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what part of the cerebellum do childhood medulloblastomas typically affect
|
midline cerebellar vermis (flocculonocular lobe)
|
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Wernicke's encephalopathy
|
encephalopathy
ophthalmoplegia - bilateral CN VI gait ataxia |
|
Friedreich's ataxia
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atrophy of spinocerebellar pathway
CST degeneration posterior column degeneration peripheral neuropathy GAA trinucleotide on chromosome #9 |
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seizure mediation with side affects of ataxia, nystagmus, and lethargy if taken in excess
|
phenytoin
|
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which cranial nerve is used to smell salts
|
CN V
|
|
causing for anosmia
|
head trauma
parkinson's olfactory groove meningioma |
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most epileptic part of the brain
|
uncus - foul odor (burnt rubber)
|
|
monocular vision loss
decreased visual acuity pain behind the eye afferent pupillary defect |
optic neuritis (MS)
|
|
pituitary adenoma (prolactinoma) and vision loss
|
optic chiasm lesion
bitemporal hemianopsia |
|
anterior choroidal stroke
|
contralateral hemianopsia with central break-line zone
contralateral hemiplegia hemisensory loss |
|
optic radiation lesion
|
MCA stroke
contralateral homonymous hemianopsia |
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PCA stroke and vision loss
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contralateral homonymous hemianopsia with macular sparing
|
|
thalamic nuclei:
VPL VPM LGB MGB VL DM |
VPL - somatosensory
VPM - facial sensory and taste LGB - primary visual MGB - primary auditory VL - primary motor cortex from cerebellum DM - from amygdala to prefrontal cortex |
|
lesion of the subthalamus
|
hemiballimus
|
|
consists of the pineal gland and the habenular nuclei
|
epithalamus
|
|
pinealmoas
|
can cause hydrocephalus or vertical gaze palsy
|
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contains the descending motor fibers from the motor cortex to the brain stem (corticobulbar tract)
|
genu
|
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occlusion of the lenticulostriate artery from the MCA
|
pure motor stroke - posterior limb of the internal capsule
|
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occlusion of the thalamogeniculate artery from the PCA
|
pure sensory stroke - posterior limb of the internal capsule
|
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lesion of the genu
|
lower facial weakness
|
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pseudobulbar palsy
|
multiple subcortical strokes that destroy a large percentage of the corticobulbar tract - dyarthria, dysphagia, emotional incontinence
|
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conduction aphasia
|
lesion of the arcuate fasciculas - cannot repeat
|
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Right hemonymous hemianopsia
alexia without agraphia |
Left PCA stroke involving the splenium of the corpus callosum
|
|
connects the hippocampal formations and temporal lobe structures
|
anterior commissure
|
|
accomoodation is normal in patients with an INO
|
Multiple sclerosis
|
|
inhibits the peripheral degradation of levodopa
|
carbidopa
|
|
side effects of levodopa
|
nausea
hallucinations dyskinesias |
|
dopamine agonists
|
ropinirole
pramipexole |
|
side affects of DA agonists
|
nausea
hallucinations gambling sleep attacks compulsive behavior |
|
medication used for treatment of tremor in parkinson's
|
anticholinergic:
trihexyphendyl benztropine |
|
drugs that cause parkinsonism
|
drugs that block DA:
antiemetics - metoclopramide and prochlorperazine neuroleptics - haloperidol |
|
unique feature of progressive supranuclear palsy that sets apart from parkinson's
|
vertical supranuclear palsy
early falling |
|
Shy-Dragar syndrome
|
multisystem atrophy
parkinsonism with profound autonomic insufficiency |
|
trinucleotide CAG repeat on chromosome #4
|
Huntington's disease
|
|
Wilson's disease
|
defect of copper metabolism
any movement disorder in a young individual proximal tremor kaiser-Fleischer ring |
|
eye looking away from the hemiparesis
|
MCA stroke
|
|
eyes looking at the hemiparesis
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pontine stroke or hemorrhage
|
|
posterior left MCA stroke
|
supplies the supramarginal and angular gyrus - Gerstmann's syndrome
agraphia, acalculia, finger agnosia, right left confusion |
|
contralateral leg motor and sensory deficits, bladder function is also impaired
|
ACA stroke
|
|
most common lacunar stroke
|
pure motor stroke - lenticulostriate artery
|
|
Amaurosis Fugax
|
transient loss of vision in one eye due to TIA - extracranial carotid artery disease
|
|
four most common locations for hypertensive hemorrhage
|
putamen - contralateral hemiplegia and hemisensory loss
thalamus - contralateral hemisensory loss and hemiplegia with decreased vertical eye movement pons - coma and pinpoint pupils cerebellum - occpital headaches, ipsilateral ataxia and nystagmus |
|
used for abortive therapy of heacaches
|
sumatriptan - may cause coronary artery vasospasm and should not be used in patients with coronary artery disease and uncontrolled HTN
|
|
treatment of cluster headache
|
high flow oxygen
|
|
drug of choice for primary generalized epilepsy
|
valproic acid
|
|
what happens if you occlude the cerebral aqueduct
|
normal size 4th ventricle with large 3rd and lateral ventricles
|
|
associated with xanthochromia
|
subarachnoid hemorrhage
|
|
Kluver-Bucy syndrome
|
head trauma affecting the bilateral medial temporal lobes involving the amygdala resulting in docility with decreased fear response
|
|
Papez circuit
|
hippocampus - fornix - mammilary bodies - thalamis fasciculus - anterior nucleus of the thalamus - cingulate gyrus - hippocampus
|
|
what are schwann cells and PNS neurons associated with
|
neural crest origin
|
|
where do microglia originate from
|
mesoderm
|
|
what do CNS neurons and ependymal cells originate from
|
neuroectoderm
|
|
this cells maintain the BBB, form reactive gliosis in response to injury, and have GFAP marker
|
astrocytes
|
|
what cells fuse to form multinucleated giant cells in CNS in HIV-infected individual
|
microglia
|
|
these cells look like fried eggs on H&E staining in CNS
|
oligodendrocytes
|
|
these cells are destroyed in Guillain-Barre syndrome
|
Schwann cells
|
|
what two neurotransmitters are decreased in Huntington's disease
|
ACh
GABA |
|
3 specialized brain areas with fenestrated capillaries and no BBB
|
area postrema - vomiting
OVLT - osmotic sensing neurohypophysis - ADH/oxytocin release |
|
differentiate the later and ventromedial hypothalamus
|
lateral - hunger
ventromedial - satiety *both are affected by leptin, leptin inhibits hunger |
|
what hormones do the supraoptic nucleus and paraventricular nucleus of the hypothalamus make
|
supraoptic - ADH
paraventricular - oxytocin |
|
differentiate the lateral and medial geniculate nucleus of the thalamus
|
lateral - CN II input for vision
medial - superior olive and inferior colliculus input for hearing |
|
differentiate the VPL and VPM of the thalamus
|
VPL - spinothalamic and dorsal column input sensory
VPM - trigeminal and gustatory sensory |
|
5 components of the limbic system
|
cingulate gyrus
hippocampus fornix mamillary bodies septal nucleus |
|
breakdown of the spinal nerve
|
31 total:
8 cerival 12 thoracic 5 lumbar 5 sacral 1 coccygeal |
|
what disease can be caused by a defect in superoxide dismutase 1 (SOD1)
|
ALS
|
|
differentiate function of superior and inferior colliculi
|
superior - conjugate vertical gaze center
inferior - auditory |
|
what can a pinealoma damage
|
superior colliculus resulting in paralysis of vertical gaze center
|
|
differentiate where V1, V2, and V3 exit the skull
|
V1 - superior orbital fissure
V2 - foramen rotundum V3 - foramen ovale |
|
what exit the superior orbital fissure
|
CN III, IV, V1, and VI
|
|
CN associated with the cavernous sinus
|
CN III, IV, V1, V2, and VI
|
|
muscle that opens the jaw
|
lateral pterygoid
|
|
muscles that close the jaw
|
masseter
temporalis medial pterygoid |
|
differentiate LMN and UMN lesion of the facial nerve
|
UMN lesion - contralateral paralysis of the lower face only
LMN lesion - ipsilateral paralysis of upper and lower face |
|
most common primary brain tumor
|
glioblastoma multiforme
|
|
this brain tumor is associated with pseudopalisading and areas of necrosis and hemorrhage
|
glioblastoma multiforme
|
|
this brain tumor is associated with being S-100 positive
|
schwannoma
|
|
this brain tumor is associated with fried egg cells that are often calcified
|
oligodendroglioma
|
|
GFAP positive childhood tumor with rosenthal fibers
|
pilocytic astrocytoma
|
|
PNET tumor with rosettes and small blue cells
|
medulloblastoma
|
|
tumor most commonly found in the 4th ventricle with characteristeic perivascular pseudorosettes
|
ependymoma
|
|
this brain tumor is most often cerebellar and associated with von Hippel-Lindau syndrome
|
hemangioblastoma
|
|
associated with port-wine stains (nevus flammeus), leptomeningeal angiomas, and pheochromocytomas
|
Sturge-Weber syndrome
|
|
lysosomal storage disease due to arylsulfatase A deficiency that causes demyelination
|
metachromatic leukodystrophy
|
|
hereditary motor and sensory neuropathy
|
Charcot-Marie-Tooth disease
|
|
unilateral headache with photophobia and aura of neurologic symptoms before headache
|
migraine
|
|
unilateral repetitive brief headache characterized by periorbital pain with ipsilateral lacrimation and rhinorrhea
|
cluster headache
|
|
differentiate peripheral and central vertigo
|
peripheral - inner ear etiology (semicircular canal, vestibular nerve, Meniere's disease)
central - brain stem or cerebellar |
