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Goljan HY CNS
| Question | Answer |
|---|---|
| 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
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