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