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Goljan HY CNS

CSF choroid plexus in ventricles; enters subarachnoid space; removed by arachnoid granulations
CSF less protein and glucose than serum; scant number of cells; ↑ chloride
Xanthochromia yellow colored CSF due to bilirubin pigment; indicates subarachnoid hemorrhage
Papilledema of optic nerve sign of cerebral edema (intracranial hypertension)
Uncal herniation intracranial hypertension; medial portion temporal lobe through tentorium cerebelli
S/S midbrain hemorrhage; CN III palsy (pupil down/out); mydriasis
Mydriasis in uncal herniation compression of parasympathetic system
Cerebellar tonsils herniate into foramen magnum intracranial hypertension
Hydrocephalus ↑ CSF volume with distention of ventricles
Non-communicating blockage aqueduct Sylvius MCC newborn
Communicating choroid plexus papilloma; scarring of arachnoid granulations
Adults with hydrocephalus progressive dementia, wide-based gait, urinary incontinence; THINK
Open neural tube defects folate must be adequate before pregnancy; ↑ AFP
Spina bifida occulta dimple overlying skin L5-S1; vertebral arch not completely closed
Meningocele vertebral defect with meninges
Meningomyelocele vertebral defect with meninges and spinal cord
Arnold Chiari syndrome elongation medulla/cerebellar tonsils through foramen magnum
S/S hydrocephalus, syringomyelia, meningomyelocele
Dandy Walker syndrome hypoplasia of cerebellar vermis; hydrocephalus
Syringomyelia enlarged cervical cord; fluid filled cyst in cervical spinal cord
S/S loss pain/temperature upper extremities (spinothalamic); motor loss in hands (anterior horn cells)
Tuberous sclerosis AD; mental retardation; hamartomas CNS/kidney; shagreen patches skin
Tuberous sclerosis angiomyolipomas kidneys; rhabdomyoma of heart
Neurofibromatosis AD; pigmented neurofibromas; cafe au lait spots
Associations pheochromocytoma, brain tumors, acoustic neuromas
Meningitis nuchal rigidity
CSF findings viral meningitis ↑ CSF protein, normal CSF glucose, ↑ lymphocytes
CSF findings bacterial meningitis ↑ CSF protein, ↓ CSF glucose, ↑ neutrophils
Encephalitis inflammation of brain; mental status abnormalities; coma
Coxsackievirus MCC viral meningitis
HSV-1 hemorrhagic necrosis in temporal lobes
Rabies skunk and bat common vectors; Negri bodies in neurons; hydrophobia; flaccid paralysis
CMV intranuclear inclusions; periventricular calcification in congenital infection
Polio virus destruction of anterior horn cells; flaccid paralysis
Subacute sclerosing panencephalitis slow virus disease due to rubeola (measles virus)
Progressive multifocal leukoencephalopathy slow virus disease due to JC virus; common in AIDS
Creutzfeldt-Jakob disease prions; spongiform encephalopathy
Risk factors contact with human brain or contaminated beef (bovine disease)
Meningitis newborn Streptococcus agalactiae (group B) MCC; E. coli, 2nd MCC
Listeria monocytogenes newborn meningitis; gram + rods; pregnant mother should avoid soft cheeses
Neisseria meningitidis MCC meningitis 1 month - 18-yrs-old; petechia and DIC characteristic
Streptococcus pneumoniae MCC meningitis >18-yrs-old
Mycobacterium tuberculosis complication primary TB; base of brain meningitis with vasculitis
Neurosyphilis CSF with positive VDRL
Meningovascular syphilis vasculitis causing strokes
General paresis syphilis with dementia and brain atrophy
Tabes dorsalis posterior root ganglia/posterior column; ataxia; absent deep tendon reflexes; Argyll-Robertson pupil
Argyll-Robertson pupil pupil accommodates but does not react to direct light; THINK
Cryptococcus neoformans MC opportunistic CNS fungal disease; positive India ink
Mucor species frontal lobe abscess in diabetic ketoacidosis
Toxoplasma gondii MCC space occupying lesion in AIDS; avoid cat litter and raw meat in pregnancy
Congenital toxoplasmosis calcification basal ganglia; blindness; mental retardation
Naegleria and Acanthamoeba amoeba in fresh water; meningoencephalitis
Taenia solium pork tapeworm; adult with worms definitive host; adult with larva intermediate host
Cysticercosis larval form of T. solium; produces blindness and calcified cysts in CNS (seizures)
Coup injuries contusions at site of injury
Contrecoup injuries contusion on opposite side of injury; frontal and temporal lobes
Epidural hematoma temporoparietal skull fracture; tear middle meningeal artery
Subdural hematoma tear bridging veins; venous blood clot; fluctuating levels of consciousness
Hypoxic injury neurons more susceptible to damage than neuroglial cells
Laminar necrosis liquefactive necrosis at watershed areas in cortex
Atherosclerotic stroke pale infarction (liquefactive necrosis) extending to periphery of cerebral cortex
Causes atherosclerotic stroke thrombosis of middle cerebral artery or carotid artery
MCA stroke contralateral weakness/sensory loss; expressive aphasia if left hemisphere stroke
Amaurosis fugax loss vision described as curtain going down and then up
Cause embolus atherosclerotic plaque to branch of retinal artery (Hollenhorst plaque)
Vertebrobasilar stroke vertigo, ataxia, ipsilateral sensory loss face/contralateral hemiparesis/sensory
Embolic stroke hemorrhagic infarction extending to periphery cerebral cortex due to embolization
Intracerebral hemorrhage complication hypertension
Cause of intracerebral hemorrhage rupture of aneurysm of lenticulostriate vessels
Location of intracerebral hemorrhage basal ganglia MC site
Subarachnoid hemorrhage rupture of congenital berry aneurysm; severe occipital headache
Lacunar stroke microinfarctions; due to hyaline arteriolosclerosis (hypertension, diabetes)
Pure motor stroke posterior limb internal capsule
Pure sensory stroke thalamus
Multiple sclerosis autoimmune destruction myelin sheath/oligodendrocytes; plaques in white matter
S/S scanning speech, intention tremor, nystagmus, paresthesias, weakness
Bilateral internuclear ophthalmoplegia multiple sclerosis; demyelination MLF
CSF with oligoclonal bands sign of demyelination
Central pontine myelinolysis rapid intravenous correction of hyponatremia in alcoholic
Alzheimer’s disease MCC dementia Alzheimer’s disease
Alzheimer’s disease ↑ amyloid-ß destroys neurons; occipital lobe spared
Alzheimer’s disease ↑ density of neurofibrillary tangles and senile plaques
Down syndrome develop Alzheimer’s disease at early age; 3 functioning chromosome 21s
Apo E gene allele ε4 gene product has high affinity for amyloid-ß
Parkinson’s disease depigmentation substantia nigra neurons; Lewy bodies; ↓ dopamine
S/S extrapyramidal (muscle rigidity), resting tremor, festinating (shuffling) gait
Causes CO poisoning, Wilson’s, MPTP (meperidine derivative), drugs
Huntington’s disease AD; atrophy of the head of the caudate nucleus; trinucleotide repeat disorder (anticipation)
S/S movement disorder; dementia
Amyotrophic lateral sclerosis (ALS) degeneration of lower/upper motor neurons; no sensory changes
Werdnig Hoffman disease childhood type of ALS
Wilson’s disease AR; excess copper; cystic degeneration of putamen/globus pallidus
Vitamin B12 deficiency posterior column (↓ proprioception, vibration); lateral corticospinal tract (UMN)
Alcohol Wernicke-Korsakoff syndrome, cerebellar atrophy, central pontine myelinolysis
Wernicke encephalopathy thiamine deficiency; IV with glucose can prompt acute attack
Wernicke encephalopathy mammillary body hemorrhage (ring hemorrhages)
S/S confusion, ataxia, nystagmus, ophthalmoplegia
Korsakoff's psychosis limbic system; antegrade and retrograde memory deficits
Acute intermittent porphyria (AIP) AD; deficiency uroporphyrinogen synthase; ↑ porphobilinogen
S/S drug induced (alcohol, barbiturates); abdominal pain (“bellyful of scars”); dementia
Window sill test urine in AIP colorless; turns port wine color with exposure to light (porphobilin)
Rx heme infusions (inhibits δ-aminolevulinic acid synthetase)
Adult brain tumors 70% supratentorial; frontal lobe MC site
Childhood brain tumors 70% infratentorial; cerebellum MC site
Adult brain tumors (descending order) GBM, meningioma, acoustic neuroma
GBM high grade astrocytoma; hemorrhage and necrosis; may cross corpus callosum
Meningioma female dominant; arise from arachnoid granulations; psammoma bodies; seizures
Acoustic neuroma schwannoma of the VIIIth nerve; tinnitus; sensorineural hearing loss; neurofibromatosis
Childhood brain tumors astrocytoma cerebellum (MC), medulloblastoma
Astrocytoma MC primary brain tumor; frontal lobe MC site in adult; cerebellum MC site in child
Medulloblastoma malignant tumor cerebellum; invades fourth ventricle
Ependymoma arises in 4th ventricle in children and cauda equina in adults
Oligodendroglioma frontal lobe tumor with dystrophic calcification
CNS lymphomas metastasis MCC; primary CNS lymphoma associated with EBV in AIDS
Metastasis MC brain malignancy; lung cancer MC site of origin; junction gray and white matter
Schwannoma benign tumor Schwann cell; MC peripheral nerve tumor; alternating dark and light areas
AIDS dementia due to HIV; multinucleated microglial cells
CMV retinitis MCC of blindness in AIDS; Rx. ganciclovir (foscarnet if unsuccessful)
Peripheral neuropathy myelin destruction (sensory; paresthesias); axon destruction (muscle atrophy)
Peripheral neuropathy DM MCC; thiamine/pyridoxine deficiency; vinca alkaloids (vincristine)
Guillain-Barre syndrome MCC autoimmune demyelination of peripheral and spinal nerves
Risk factors M. pneumoniae, influenza vaccine, Campylobacter jejuni
S/S ascending paralysis; CSF increased protein, lymphocytes; Rx. plasmapheresis
Charcot-Marie-Tooth AD; common peroneal nerve palsy; inverted bottle appearance
Idiopathic Bell’s palsy facial muscle paralysis due to inflammation of cranial nerve VII
Lyme disease facial nerve MC cranial nerve involved; bilateral Bell’s palsy
Bacterial conjunctivitis Staphylococcus aureus
Viral conjunctivitis adenovirus MC; HSV-1 (dendritic ulcers)
Sudden loss of vision amaurosis fugax, central retinal artery or vein occlusion
Uveitis inflammation of iris, choroid, ciliary body; blurry vision; ankylosing spondylitis, sarcoidosis
Optic neuritis multiple sclerosis MCC; methyl alcohol poisoning
Glaucoma increased intraocular pressure; fluid cannot exit canal of Schlemm; causes optic atrophy
Optic atrophy blindness; pale disc; glaucoma, optic neuritis
Macular degeneration MCC permanent visual loss in elderly
Meniere’s disease increased endolymph; tinnitus, vertigo, sensorineural hearing loss
Presbycusis MCC sensorineural hearing loss in elderly
Otosclerosis MCC conductive hearing loss in elderly; fusion of ear ossicles
Impacted wax in outer ear canal conduction hearing loss
Weber test lateralizes to left ear, bone>air conduction (Rinne test) conduction loss left ear
Weber test lateralizes to left ear, air>bone conduction both ears sensorineural hearing loss right ear
Otitis media MCC conduction hearing loss in children; S. pneumoniae MCC
Malignant external otitis in diabetic Pseudomonas aeruginosa
Created by: megankirch