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S&D block 4 ben

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QuestionAnswer
What is the cause of acute pyogenic meningitis in neonates? adolescence? Elderly? Neonates = E Coli, Group B Strep, Adolescents = Neisseria Meningitidis with possible pandemic spread Elderly = Streptococcus Pneumonia and Listeria Monocytogenes
What would be found in the CSF of acute pyogenic meningitis Cloudy, purulent, increased pressure CSF with neutrophils ↑↑Protein, ↓↓glucose. Lactate Dehydrogenase is increase
What is the cause of acute aseptic meningitis Usually an enterovirus in 80% of cases: Echovirus, Coxsackievirus, Polio. May also because of rickettia
What would be found in the CSF of acute aseptic meningitis ↑Lymphocytes (pleocytosis) instead of PMNs in pyogenic meningitis Normal glucose concentration, ↑Protein, no purulence in CSF
Name the most common causes of Acute Focal Suppurative Infection brain abscess (2) Streptococcus and Staphylococcus
what are five complications from Acute Focal Suppurative Infections brain abscess 1.Thrombophlebitis 2.Venous occlusion 3.Brain infarction 4.Meningitis 5.Ventriculitis
what causes an acute focal suppurative subdural hemotoma bacteria or fungi infection between dura and arachnoid
what is a Pott’s Puffy Tumor (sinusitis that leads to osteomyelitis) associated with? acute focal suppurative extradural abscess
Name this disease: chronic infection of the meninges and brain caused by: Mycobacterium tuberculosis Treponema pallidum Borrelia species Chronic Bacterial Meningoencephalitis
name this disease: Subarachnoid space contains a gelatinous or fibrous exudate at the base of the brain. Its complications: May cause obliterative endarteritis leading to infarction, May cause arachnoid fibrosis leading to hydrocephalus Tuberculous Meningoencephalitis
Meningovascular Neurosyphillis leads to what and occurs where? obliterative endocarditis and at the base of the brain or the spinal cord
Paretic Neurosyphillis occurs leads to what and occurs where? dementia from damage to the frontal lobe
Neurocysticercosis is the result of accidental ingestion of eggs of ___________(ie, pork tapeworm), usually due to contamination of food by feces of people Taenia solium
Stages of NC on ct scan: Vesicular stage (viable larva): Hypodense, nonenhancing lesions
Stages of NC on ct scan: Colloidal stage (larval degeneration): Hypodense/isodense lesions with ring/peripheral enhancement and perilesional edema
Stages of NC on ct scan: Nodular-granular stage Nodular enhancing lesions
Stages of Neurocystcoidosis on ct scan: Calcified stage parasite dies and nodular parenchymal calcifications are seen
There is a genetic link, on chromosome 20, PRNP gene, which ↑ risk of PrPsc formation, particularly in familial prion diseasee. what is it? Met →Val @ codon 129
what are the four phases of migraines? 1.Prodrome 2.Aura 3.Headache phase 4.Postdrome
The following symptoms are associtated with which phase of migraines? When do they occur? 1.Aphasia: difficulty speaking/finding words 2.Constipation/diarrhea 3.Difficulty concentrating 4.Excessive yawning 5.Fatigue 6.Food cravings Prodrome; Hours or days before
The following symptoms are associtated with which phase of migraines? 1.Touch hypersensitivity 2.Aphasia 3.Auditory hallucinations 4.Loss of hearing or ↓hearing 5.Confusion 6.Hemiplegia/hemiparesis 7.Parasthesia Aura;
The following sxms are associtated with which phase of migraines?1.freq unilateral 2.Shifts sides 3.becomes bilat. 4.bilat. entirely 5.worsened by phys activity 6.4-72 hrs in adults (1- 72 hrs in kids) 7.Pain around eyes, sinuses, teeth, & jaw Headache
The following symptoms are associtated with which phase of migraines? 1.Fatigue 2.Poor concentration 3.Depression/ euphoria Postdromal
what is the diagnostic criteria for migraine? Repeated attacks of headache lasting 4- 72 hours with normal PE and no other reasonable cause for the headache AND At least 2 of the following features: Unilateral headache Throbbing pain Aggravated by mvmt Moderate/severe intensity PLUS 1 of the fo
Name the Non pharmacologic management of Migraine (5) 1.Healthy diet 2.Regular exercise 3.Regular sleep patterns 4.Avoidance of excess caffeine /alcohol 5.Avoidance of acute changes in stress levels
How is a chronic Migraine diagnosed? Occurs at least 15 days of the month for more than 3 months
what is an acephalgic migraine Aka Silent Migraine, eye migraine. It has typical aura w/o headache and repeated neurological sxms. Also with N/V, vertigo, and brain stem symptoms
what is the txment for episodic tension headaches? 1.Simple analgesics/ NSAIDs 2.Relaxation 3.Triptans (serotonin receptor antagonists) effective only if the patient also has migraine
what is the txment for chronic tension headaches? Amitriptylline (tricyclic antidepressant) is the only proven treatment
what is Trigeminal Autonomic Cephalalgia (TAC)? Short lasting attacks of head pain associated with cranial autonomic symptoms
what are the sxms of Trigeminal Autonomic Cephalalgia (TAC)? 1.Cranial Autonomoic symptoms 2.Lacrimation 3.Conjunctival injection 4.Nasal congestion / rhinorrhea 5.Forehead/ facial sweating 6.Eyelid edema
what are the characteristic of a cluster headache? 1.Deep px, retro orbital 2.Excruciating intensity 3.Explosive quality, Non fluctuating 4.Periodical: At least 1 of the daily attacks recurs at the same hour each day for the duration of the cluster bout 5.Men affected 3 x more often than women
Describe paroxysmal hemicrania (PH) 1.Unilateral, severe, lasting (2-45 min) 2.Frequent attacks (>5 a day) 3.Pain is usually retro-orbital (may be generalized) 4.Marked autonomic features, ipsilateral to pain 5.Labeled as Episodic when there are remissions Chronic when non remitting
what is the txment of Paroxysmal Hemicrania (PH)? Indomethacin; started at low dosage, gradually increased till effective (8hrs-5 days) and then tapered down and stopped
What is secondary paroxysmal hemicrania? Paroxysmal hemicrania like symptoms have been reported with lesions in the sella turcica (AV malformations, cavernous sinus meningioma, pituitary pathology, epidermoid tumors)
What do SUNCT & SUNA stand for? Short-lasting Unilat. Neuralgiform h/a attack w/ Conjunctival injection & Tearing: ≥20 attacks, lasts 5-240 sec. ipsilat conjunctival injection & lacrimation; Short-lasting Unilat Neuralgiform h/a attack w/ cranial Autonomic sxm (No conjunct. inject, lac)
what is the diagnostic feature of hemicrania continua it resolves completely w/ indomethacin (I/M, oral for at least 2 wks)
What are the first (2) and secondary (5) types of new daily persistent headache (NDPH) Primary: Migrainous type Tension type Secondary: Subarach. Hemorrhage ↓ CSF volume ↑ CSF pressure Post trauma Chronic meningitis
what kind of secondary headaches can lead to blindness if not treated on time? Glaucoma & Giant cell arteritis
differences between meningitis and intracranial hemorrhage dxs? intracranial hemorrhage has no fever, usually dx with CT scan.
what kind of headaches have sxms such as Intermittent deep dull aching of moderate severity and Worsening on exertion or change in position brain tumor associated headaches
how do you confirm diagnosis of giant cell arteritis biopsy temporal artery
what is the treatment for giant cell arteritis? Prednisone and Methylprednisolone (if ocular symptoms appear)
most common cause of primary headaches? tension
most common cause of secondary headaches systemic infection
__________: deep sleep like state from which the patient cannot be aroused Coma
______________: awake appearing but nonresponsive state in a patient who has emerged from coma (awake coma) Vegetative state
___________________________: awake appearing with rudimentary vocal /motor behaviors Minimally conscious state
What conditions that can be confused with coma or vegetative state? (3) 1.Akinetic mutism 2.Catatonia 3.Locked in syndrome
what part of the reticular formation is responsible for maintaining consciousness Ascending (also called RAS)
if patient has a preserved pupillary reactions and eye movements in a comatose state what CNS area can you exclude? upper brainstem lesion (points to cerebral hemisphere lesion)
Uncal transtentorial herniation is an impaction of uncus into the tentorial opening adjacent to midbrain; compresses ______ CN III
Central transtentorial herniation symmetrical downward movement of thalamic structures; compresses _____________ upper midbrain
what would central transtentorial herniation with bilateral small reactive pupils is indicative of? Diencephalon compression leading to sympathetic impairment
what would central transtentorial herniation with bilateral mid-position fixed pupils is indicative of? Midbrain compression leading to impairment of sympathetic & parasympathetic fibers
a multifocal myoclonus sign may indicate what when assessing a comatose patient? metabolic disorder
papillary signs in a comatose pt: One enlarged (>6mm) & nonreactive pupil signifies? compression / stretching of CN III
papillary signs in a comatose pt: Oval eccentric pupil is a transitional sign what? early midbrain-CN III compression
Spontaneous ocular movements resting position: slightly divergent in __________; parallel in _______ drowsiness; coma
describe ocular bobbing brisk downward and slow upward movements of the eyes
Ocular bobbing with loss of horizontal eye movements is indicative of what? bilateral pontine damage usually from basilar artery thrombosis
Ocular dipping with normal reflex horizontal gaze is indicative of what? diffuse cortical damage e.g. anoxia
describe ocular dipping slow arrhythmic downward and faster upward movement
Vestibuloocular test in awake person would have nystagmus (fast movement towards opposite/same ear) oppisite
Respiratory patterns: Cheyne Strokes are indicative of bihemispherical damage/metabolic suppression(usually in light coma)
Respiratory patterns: slow, shallow regualr strokes are indicative of? drug/metabolic depression
Respiratory patterns: Kussmaul breathing is indicative of? metabolic acidosis/less commonly pontomesencephalic lesions
Respiratory patterns: Agonal gasps are indicative of? lower brainstem(medulla) damage (recognized as terminal respiratory pattern of severe brain damage)
Decribe oculocephalic reflex 1-head rotated left and right +response ->eyes rotate to the opp side (intact CN3,6,8) 2- head tilted up or down +eyes go to oppisite sie (intact CN3,4,8) Positive response --> intact brainstem
in a comatose pt an enlarged pupil, Loss of light reaction & Loss of eye movements suggests what? upper brainstem lesion
A state of wakefulness & awareness w/ quadriplegia & paralysis of the lower CN Not able to show facial expression, move, speak, or communicate Communication possible by eye movements Typically results from a pontine hemorrhage or infarct Locked-in syndrome
rare disorder Partially or fully awake patient who does not move or speak Results from damage in the medial thalamic nuclei, orbito-frontal surfaces of frontal lobe or extreme hydrocephalus Able to think and form impressions Akinetic Mutism
hypomobile and mute condition associated with psychiatric disorders Characterized by few voluntary or responsive movements Eyelid elevation is actively resisted Eyes move concomitantly with head rotation Waxy flexibility may be present Catatonia
4 Diseases without focal/lateralizing neurological signs that result in comas Intoxications: alcohol, sedatives, opiates Metabolic : anoxia, hyponatremia, hypercalcemia, hypoglycemia, hyperosmolar , Addisonian crisis, uremic or hepatic encephalopathy, hypo- or hyperthyroidism, Severe systemic infections: pneumonia, septicemia,
_________ hemorrhage causes occipital headache, vomiting, gaze paresis, inability to stand & walk Cerebeller
________ hemorrhage casues sudden onset, pinpoint pupils, loss of reflex eye movements& corneal reflex, ocular bobbing, posturing, hyperventilation Pontine
________ ______ and _______________ hemorrhage causes acute onset, vomiting, headache, hemiplegia, eye signs Basal ganglia and thalamic
________ artery thrombosis causes diplopia, dysarthria, vomiting, abnormal eye movements and corneal reflex, asymmetric limb paresis Basal
___________ hemorrhage causes severe sudden headache & vomiting immediately followed by coma) Subarachnoid
what are the 4 Indicators for Endotracheal intubation 1.Infrequent, shallow, or stertorous respirations 2.Low O2 saturation (determined by pulse oximetry or ABG measurements) 3.Impaired airway reflexes 4/Severe unresponsiveness (GCS ≤ 8)
_______________ comas have far better prognosis than the traumatic ones Metabolic
Unresponsiveness for less than _ hours is favorable 6
Glasgow Coma Scale is more predictive of outcome in _____________ coma as compared to coma due to other causes traumatic
For _________- and __________coma, pupillary and motor responses after 1 day, 3days , & 1 week have predictive value anoxic; metabolic
give GCS number(s) for each blank: 1.____deepest level coma; totally unresponsive. 2._____severe injury ( comatose). 3._____ not in a coma, but not fully alert. 3- deepest level coma; totally unresponsive 3-8 - severe injury ( comatose) 9 – not in a coma, but not fully alert
Give GCS number(s) for each blank: 1.moderate injury 2.mild brain injury (may be loss of consciousness of < 20 minutes duration) 3.fully conscious 9-12 – moderate injury 13-15 – mild brain injury (may be loss of consciousness of < 20 minutes duration) 15 – fully conscious
what is a persistent vegetative state? a VS > 1month
how is a vegetative state diagnosed? 1. No purposeful activity 2.Signs of intact reticular formation: autonomic and motor rflxs and sleep-wake cycles, eye movements, yawns, and involuntary mvmt to noxious stimuli 3.Prolonged observation needed for evidence of minimally conscious state
Recovery unlikely after __ month in non traumatic brain injury & after __ months in traumatic injury 1; 12
About 1/3 of brain abscesses are associated with _____________ & __________ often with cholestemea otitis media; mastoiditis
4 types of gliomas Astrocytomas Ependymomas Oligodendrogliomas- cells have variable GFAP but are S100+ Glioblastoma
what is the difference between Pilocytic astrocytoma Well differentiated astrocytoma Pilocytic astrocytoma: (no p53 loss) Well differentiated astrocytoma: (p53 loss and PDGF A overexpression)
Anaplastic astrocytoma occurs from a loss of what genes (loss of RB and P16)
what gliomoa occurs in the optic nerves, cerebellum, brain stem, or temporal lobes. Im Children and young adults and is Well circumscribed Pilocytic Astrocytoma
____________ fibers are elongated, eosinophilic, proteinaceous inclusions found in the processes of pilocytic astrocytomas. Rosenthal
how can you differentiate The pilomyxoid astrocytoma and pilocytic astrocytoma typical pilomyxoid astrocytoma lacks eosinophilic granular bodies and Rosenthal fibers
chromosomal abnormalities, with the largest study to date finding a loss on chromosome __ (most commonly affecting 9p21 locus) ___________ mutations have been described in approximately 50% of PXAs 9;BRAFv600e
a tumor of infants that may be found throughout the CNS but that has preference for the supratentorial regions. The are characterized by an attachment to the dura, cystic features, as well as by a dense collagenous stroma Desmoplastic Astrocytoma-
what can be used to distinguish between the astrocytes and fibroblasts in desmoplastic astrocytoma? The glial fibrillary acidic protein (GFAP)
Russell bodies are often associated with what tumors? helps to distinguish from other gliomas arsing in hypothalamus Chordoid Glioma of the Third Ventricle
this neoplasm is defined as a solid, circumscribed, low-grade, spindle-cell astrocytic tumor of adults having an origin in the posterior pituitary or its stalk Pituicytoma
a rare tumor that occurs in the wall of the lateral ventricle and foramen of Monro, and, rarely, in the third ventricle is a tumor that occurs in patients with tuberous sclerosis (TS) Subependymal giant cell astrocytoma (SEGA)
Subependymal giant cell astrocytoma (SEGA) has a germline mutation where? TSC1 or TSC2
Typically presents in fifth decade, the neoplasm is histologically less well differentiated. The neoplastic cells are more numerous, more pleomorphic, and more often found in mitotic division. Vascular proliferation also found. Anaplastic Astrocytoma
-tumors in which the predominant neoplastic astrocyte shows a brightly eosinophilic cell body from which emanate abundant, stout processes. Gemistocytic astrocytoma
is a diffuse glioma with extensive infiltration of multiple regions of the brain Gliomatosis cerebri
Most common adult primary brain tumors, WHO grade IV/IV. Well differentiated astrocytoma. Typically occurs in adults over the age of 45, or in the brain stem of children Glioblastoma Multiforme
most common secondary glioblastoma -characterized by mutations of TP53, and point mutations in the isocitrate dehydrogenase genes, IDH1 and IDH2. often shows an overexpression of the receptor for platelet-derived growth factor receptor α (PDGFRA). Proneural GBM
majority of primary glioblastoma -characterized by mutations of the PTEN tumor suppressor gene, deletions of chromosome 10, -and amplification of the EGFR oncogene. Focal deletions involving chromosome 9p21 Classic GBM
What GBM is characterized by deletions of the NF1 gene on chromosome 17, and lower expression of the NF1 protein.-neurofibromin. mesenchymal GBM
what GMB is characterized by higher levels of expression of neuronal markers, including NEFL, GABRA1, SYT1, and SLC12A5. neural GBM
Children in brain (posterior fossa) Young adults in brain or cord Fifth and Sixth decades in Filum terminale Ependymoma
NF2 gene on chromosome 22 is commonly mutated in ____________ in the spinal cord but not at other sites. ependymomas
How do you differentiate ependymoma in adults and children? The intracranial lesions are most common in children where they present as masses in the 4th ventricle that obstruct the flow of cerebrospinal fluid causing hydrocephalus. Spinal cord in adults
Able to produce cerebrospinal fluid resulting in hydrocephalus. Most frequently occur in children where the lateral ventricles are Choroid Plexus Papilloma
Subtentorial childhood tumor that is very undiffertentiated. Highly malignant with dismal ultimate prognosis w/o treatment ***Very radiosensitive Medulloblastoma
describe Molecular subtypes of medulloblastoma group 1 mutations in the WNT signaling pathway, shows monosomy of chromosome 6 and nuclear expression of β-catenin.
describe molecular subtypes of medulloblastoma group 2 mutations involving the SHH pathway, may have MYCN amplification.
describe molecular subtypes of medulloblastoma group 3 MYC amplification and isochromosome 17 (i17q),
describe molecular subtypes of medulloblastoma group 4 i17q cytogenetic alteration, WITHOUT MYC amplification, but sometimes with MYCN amplification.
what molecular subtypes of medullublastoma has the best prognosis and worst best -Group 1; worst - Group 3
Another term for medulloblastoma is infratentorial primitive neuroectodermal tumor (PNET). Medulloblastoma is the most common PNET originating in the _____. brain
One of the most common of all primary intracranial neoplasms. most common in pregnant woman, however, In spinal cord M:F ratio is 1:8 Meningioma
neoplasm of chromosome 22 (monosomy or LOH) with Deletion 1q, 10, 14q a/w aggressive type Meningioma
neoplasm with blood from ECA (middle meningeal), but may parasitize vessels from ICA and develop a dual supply Meningioma
name the neoplasm: 1.Gene Name :NF 2.Location :22q12 3.Dna / Rna :Tumor suppressor gene 4.Protein: Called merlin or schwannomin 5.Germinal mutation: In neurofibromatosis type 2 patients Metastatic Neoplasm
Characteristic location is Gray-White junction Most commonly associated with a lung mass, metastasizing via the MCA Metastatic Neoplasm
CNS Tumors tend to follow epidemiologic and anatomic patterns in Children? (4) 1.Medulloblastoma 2.Pilocytic Astrocytoma 3.Glioblastoma 4.Ependymoma
CNS Tumors tend to follow epidemiologic and anatomic patterns in Young Adults (2)? 1.Well Differentiated astrocytoma 2.Pilocytic Astrocytoma
What CNS Tumors tend to follow epidemiologic and anatomic patterns in older adults (6)? 1.Metastatic Carcinoma 2.Anaplastic Astrocytoma (3/4) 3.Glioblastoma (4/4) 4.Meningioma (Women) 5.Ependymoma (Spinal Cord) 6.Lymphoma
It is the most common CNS neoplasm in immunosuppressed individuals including those with AIDS and immunosuppression after transplantation. between ages 14-60 always screen AIDS pts for this. Primary CNS lymphoma
Most ______ ______ ________ are of B-cell origin. In the setting of immunosuppression, the cells in nearly all such tumors are latently infected by Epstein-Barr virus. Primary brain lymphomas
The neoplastic Schwann cells are admixed with perineurial-like cells, fibroblasts, mast cells, and CD34+ spindle cells in what kind of neoplasm? primary tumor of schwann cells
name the three types of neurofibromas? 1.Cutaneous neurofibromas 2.Spinal Neurofibromas 3.Plexiform neurofibromas
______________________:is an Autosomal dominant genetic disease caused by heterozygous dysfunction of the NF1 tumor suppressor gene on the long arm of chromosome 17. Neurofibromatosis Type 1 (NF1)
The NF1 gene product, neurofibromin, has what kind of activating system? a RAS GTPase-activating region (GAP) and is likely involved in RAS-signaling pathway
what are three common characteristics of Neurofibromatosis Type 1 1.Glioma of optic nerve 2. Lisch nodules (pigmented nodules of iris 3. cafe au lait
Plexiform neurofibromas and malignant primary nerve sheath sarcomas(MPNST), Not encapsulated, softer (more gelatinous) than schwannoma Superficial tumors are small, pedunculated nodules protruding from skin NF1:A.k.a.Von Recklinghausen’s Syndrome
Central neurofibromatosis Inherited propensity to bilateral acoustic schwannomas, spinal cord schwannomas, meningiomas, and spinal cord ependymomas Neurofibromatosis Type 2
Increased incidence of a vascular tumor known as Hemangioblastomas of the retina and CNS Virtually all patients die of renal cell carcinoma Von Hippel-Lindau Syndrome
Characterized by increased susceptibility to multiple tumors: (astrocytomas as well as breast cancer and soft tissue cancers). The CHEK2 and TP53 genes are associated with ______________ syndrome. Li-Fraumeni
_________ ___________: Damages several nerves in a haphazard pattern, commonly due to vasculitis Mononeuritis multiplex
__________________: Affects nerve roots and peripheral nerves leading to diffuse symmetric proximal and distal deficit Polyradiculoneuropathies
Morphology of this diseasd- Segmental demyelination, chronic inflammation involving the nerve root and peripheral nerves and in severe disease there is axonal damage. Guillain – Barre Syndrome(Acute
Morphology of this disease – Onion bulb changes in the peripheral nerves due to recurrent demyelination and remyelination Treatment - Steroids Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy
_____________ leprosy- severe diffuse symmetrical polyneuropathy in the extremities, loss of pain sensation and large traumatic ulcers; __________ Leprosy- Localised nerve injury Lepromatous;Tuberculous
what infectious neuropathy has painful distal sensory neuropathy HIV
what infectious neuropathy has polyradiculoneuropathy and unilateral or bilateral facial nerve palsies Lyme disease
what infectious neuropathy has Segmental demyelination with parathesia and weakness? Diptheria
what infectious neuropathy persists in the sensory ganglion and shows neuronal destruction, associated mononuclear infiltrates with axonal degeneration in the peripheral nerves Vericella-zoster virus
JC virus. oligodendrocytes and leads to a progressive focal demyelinization with death results from diaphragmatic paralysis Progressive Multifocal Leukoencephalopathy (PML)
how do you get subacute sclerosing panencephalitis Sequella of infection with untreated measles, usually in children
_____________ is associated with Diabetic ketoacidosis and it is usually lethal once infection starts Mucor
what two fungal infections are associated with Vasculitis with thrombosis & hemorrhagic infarcts MUCOR + ASPERGILLUS
what two fungal infections are associated with parenchymal Invasion with granulomas or microabscesses CANDIDA and CRYPTOCOCCUS
Toxoplasmosis encephaliis results from __________ infecting the _________? tachyzoites; astrocytes
Granulomatous amoebic encephalitis (GAE) is caused by ______________. almost uniformilay fatal in the immuno-comprimised Acanthamoeba
Neurocysticercosis is the result of accidental ingestion of eggs of ______________ Taenia solium
what bacteria is a cause of aseptic meningitis? by R. rickettsii
spongiform transformation (pathognomonic) of grey matter in the cerebral cortex, sometimes found in deep grey matter structures (caudate/putamen). prion disease
Subtle changes in memory and behavior precede the dementia (all cortical lesions) often with involuntary jerks (basal ganglia) The disease is uniformly fatal with average survival of 7 months after the onset of the disease CJD
Slower progressive (like vCJD) but with a PNRP mutation (like CJD) Spongiform + PrPsc plaques and neurofibrillary tangles Gerstmann‐Straussler‐Scheinker
Prion disease with varying clinical course and symptoms. No spongiform, No cortical Lesions, instead, neuronal loss in thalamus and reactive gliosis Fatal Familial Insomnia (FFI)
what Benign Paroxysmal Positional Vertigo Brief episodes (seconds, rarely minutes) of vertigo typically related to changes in position, or certain positions -horizonto-rotary nystagmus -No hearing loss or tinnitus
what brain abscess stage is this? Central core of coagulative necrosis surrounded by marked edema and perivascular inflammatory cells Early cerebritis (1-3 days)
what stage brain abscess: necrotic center surrounded by a border of macrophages & fibroblasts Late cerebritis stage (4-9 days)
what stage brain abscess is this: better developed on the cortical than on ventricular side of the lesion Early capsule formation (10-13 days)
what stage brain abscess is this: dense collagenous capsule; surrounding edema regression, marked gliosis (seizures occur at this stage) Late capsule formation (day 14 onwards)
what are the 8 clinical presentation of brain abscess 1.Headache 2.Fever 3.New onset seizures 4.Focal neurological deficit 5.Hemiparesis 6.Temporal lobe abscess 7.Cerebeller abscess 8.Raised ICP
Management of Brain Abscess: Parenteral antibiotics for a minimum of __-__ weeks. Prophylactic anticonvulsant therapy should be continued for at least __ months after resolution of the abscess if EEG is normal 6-8; 3
when should you use glucocorticoids in the management of brain abcess's? in cases with substantial periabscess edema associated with mass effect
what are 3 causes of death from brain abscess's? Cause of death include 1.Intraventricular rupture of the abscess 2.intracranial hypertension ( mass effect) 3.Postoperative seizures
between High grade glioma or Low grade glioma which has a higher percentage of seizures? Impaired cognitive function?Headache? seizures: low grage (70%) Impaired Cog. Fxn and Headache: High grade (50% for both)
what is the preferred test for dx of brain tumors? MRI: done with gadolinium contrast
how are glucocorticoids useful in txting brain tumors? highly effective to reduce perilesional edema (Dexamethasone preferred due to ↓mineralocorticoid activity)
Name the brain tumor: Arise from dura mater Most commonly located over cerebral convexities Classified in to 3 histological grades: grade I (benign), grade II (atypical), grade III (malignant) meningiomas
name this tumor :The most commonly arise from vestibular part of CN VIII. Progressive unilateral hearing loss, dizziness, tinnitus and less commonly compression symptoms (cerebellum and pons) schwanomas
functioning or nonfunctioning?: usually macroadenoma (>1cm); hypopituitarism & symptoms by mass effect; headache, visual impairment. functioning or non-functioning?: usually microadenoma (<1cm); lead to specific endocrine syndromes nonfluctuating; functioning
name this tumor: Arise from remnants of Rathke’s pouch Solid or solid-cystic benign tumors Predominantly in children or btwn ages 55-65. Sxm: headache & visual impairment; impaired growth in children & hypopituitarism in adults Craniopharyngiomas
Grade ___ or anaplastic astrocytoma: generally present in 4th Or 5th decade of life; treated by ‘safe’ surgical resection followed by RT and temozolomide Grade III
Grade ___ astrocytoma (glioblastoma) accounts for majority of high grade astrocytomas (80-85 %) present in the 6th & 7th decade of life, with headache, seizures & focal neurological deficits Grade IV
Grade ___ or pilocytic astrocytoma: typically found in cerebellum but can occur in brainstem or optic nerves; curable if completely resectable Grade I
A rare non-Hodgkin lymphoma. <3% of primary brain tumors. Predilection for the periventricular white matter; most freq. found in supratentorial brain (~70%) Primary CNS lymphoma (PCNSL)
Most common malignant brain tumor of childhood (20% of all primary CNS tumors)/ Arise from granule cell progenitors from ventricular zone Meduloblastomas
Where do most brain tumors metastasize from? Mostly from lung (41%) & breast (19%)
what is it called when destruction of normal structured myelin by immune mediated attacks on myelin forming cells and myelin Demyelination
what is it called when there is degeneration of defective structured myelin (usually genetic) Dysmyelination
what are the Ancillary sxms of MS (5)? Heat sensitivity Lhermitte’s symptom – sharp shooting pain Paroxysmal symptoms. Trigeminal or glossopharyngeal neuralgia Facial spasm, Facial myokymia
what is the most common type of MS? Relapsing-Remitting MS (RRMS) 85% of the cases
What is the diagnostic criteria for MS? 1.2 > episodes of sxms separated by a mth or more and lasting for 24 hrs or more (dissemination in time, DIT) 2.Evidence of 2 anatomically noncontiguous white matter tracts of CNS (dissemination in space, DIS)   3.Other possible diagnoses are excluded
when diagnosing MS with and MRI, where are the "MS typical regions"? periventricular, juxtacortical, infratentorial, spinal cord
what is commonly found (75%>) in the CSF of MS patients? oligoclonal bands (OCB)
what sxms are associated with a more favorable (less disability) in MS? Optic neuritis or sensory symptoms at onset, <2 relapses in 1st year, minimal impairment after 5 years
what sxms are associated with a less favourable (more disability) in MS? Truncal ataxia, action tremors, progressive disease course
when do you use glucocorticoids for the txment of MS? for initial attack or acute exacerbations; IV for 3-5 days followed by oral, tapered over 2 weeks
Also known as Devic's disease, this is an aggressive inflammatory disorder characterized by recurrent attacks of optic neuritis & myelitis which can be bilateral (rare in MS) or unilateral. Associated with hypothalamic lesions and autoimmune disorders NeuroMyelitis Optica (NMO)
what is the treatment of neuromyelitis optica (NMO) High dose glucocorticoid/plasma exchange for attacks For prevention; combination regimen of glucocorticoid and azathioprine
Associated with postinfectious or postvaccinal encephalitis. Widely scattered small foci of periventricular inflammation & demyelination. Sxms include: Fever, headache, meningismus, seizures, lethargy (--> coma) Acute Disseminated EncephaloMyelitis (ADEM)
Name the disease the resembles the sxms of GBs but has an insidious onset (Progression for > 2 months). Chronic inflammatory demyelinating polyneuropathy (CIDP)
What is found in the CSF of GBS and Chronic inflammatory demyelinating polyneuropathy (CIDP) elevated protein with normal white cell count
what is the txment for GBS? Intubation (if vital capacity <15 ml/Kg) Rehydration (1 – 1.5 L urine output/day) Prevention of DVT, pressure sores Joint mvmt (passive, then active); IVIg; Plasma exchange: if IVIg ineffective *Corticosteroids not effective. delay rcvy
Autoimmune mediated acute demyelinating neuropathy with rapid onset (hours to days), triggered by infection, vaccination, or surgery  Infection is the trigger in >50% of patients Guillain-Barré syndrome (GBS)
what is Catamenial epilepsy? Seizure with onset of menses or exacerbation of seizures with menses.
Chronic obstruction of the meimobian glands (tarsal glands-) meimobian glands-supplies meibum, an oily substance that prevents evaporation of the eye’s tear film. They prevent tear spillage onto the cheek Chalazion
leading cause of blindness worldwide? Trachoma (chlamydia)
describe trachomatous inflammation follicular and trachomatous intense TF- 5> folicules in upper tarsal conjunctiva; TI- thickening of tarsal conjunctiva that obscures more than half of the deep tarsal vessels.
Inclusion bodies in scraped tissue cells are identified by iodine staining of glycogen present in the cytoplasmic vacuoles in infected cells. what distinguishes C trachomatis from C psittaci? only chlamydia trachomatis contains glucose
Sub-mucosal growth of fibrovascular connective tissue migrates onto cornea that originates in conjunctiva near limbus Pterygium
band of subepithelial actinic elastosis with variable hyalinization and calcification; associated with sun damage and ag. no encroachment on cornea Pinguecula
Both squamous neoplasms and melanocytic neoplasms and their precursors tend to develop at the _________ limbus.
mucoepidermoid carcinoma of the conjunctiva (reflecting the ability of conjunctival stem cells to differentiate into squamous _________ and _________ cells epithelium; goblet
Seldom invade the cornea or appear in the fornix or over the palpebral conjunctiva Pigmented lesions in these zones of the conjunctiva most likely represent melanomas or its precursors
Conjunctival melanomas develop from what precursor disease? Where do the lesions tend to spread first to? PAM with atypia; the parotid or submandibular lymph nodes.
________ scotoma: an area of decreased or lost vision that interferes with central vision (likely to affect daily life) Central
___________ scotoma: an area of decreased or lost vision that affects half of the central visual field Hemianopic
__________ scotoma: an area of decreased or lost vision toward the edge of the visual field (less likely to affect daily life) Peripheral
____________ scotoma: An area of decreased or lost vision near, but not in the central vision Pareacentral
A lesion to the right temporal lobe with damage specifically to Meyer's loop will give rise to what? a left upper (superior) quadrantanopsia
A lesion to the right parietal radiation with damage specifically to Baum's loop (superior trajectory) will result in what? a left lower (inferior) quadrantanopsia
disease caused by changes due to pericyte death leading to Microaneurysms and cotton wool spots Diabetic Retinopathy
disease from developing fetal retinal circulation that is selectively damaged by high concentrations of oxygen. Mechanism is suppression of VEGF-A production in the retina This is a classic cause of blindness in premature infants RETROLENTAL FIBROPLASIA (retinopathy of prematurity)
________ is caused by mutations in a gene involved in vitamin A metabolism called RPE65 LCA
what is the key test to dx Leber Congenital Amaurosis ERG. Eye examinations of infants with LCA reveal normal appearing retinas However, electroretinography (ERG) tests, which measure visual function, detect little if any activity in the retina
can happen in one eye, or both. damage to optic nerve with sxms' similar to MS. Males are affected much more often than females. Blurring and clouding of vision are usually the first symptoms of _____ LHON
Inflammation within the vitreous humor. irreversible Endophthalmitis
________________ is when the inflammation of vitreous humour within the eye involves the retina, choroid, and sclera and extends into the orbit Panophthalmitis
__________ may be manifest principally in the anterior segment of eye. May be autoimmune in origin (sympathetic ophthalmia). Uveitis
____________ is An example of noninfectious uveitis limited to the eye. It is characterized by bilateral granulomatous inflammation typically affecting all components of the uvea Sympathetic ophthalmia
Most uveal melanomas spread first to the ______, an excellent example of a tumor-specific tropism for a particular metastatic site. liver
tumor: has a clouding effect like a gray curtain moving across the field of vision. signs of retinal detachment 1.Eye floaters with eye flashes. 2.Sudden onset of blurred vision( like curtain drawn) 3.Shadows or blind spots in the field of vision Uveal melanomas
Pain--> ach’y eyes/ night blindness/ tunnel vision loss of peripheral vision Open angle glaucoma (most common)
what is the cup to disc ratio and what happens when it increases? The cup occupies 1/3 of the height of the entire disc; indicates a decrease in the quantity of healthy neuro-retinal tissue and hence, glaucomatous change.
Symptoms: Sudden blurring or painless loss of vision in all or part of one eye
Coagulopathies from sickle cell anemia or antiphospholipid antibodies are common etiologies for ______ in patients younger than 30 year. Atherosclerotic disease is the leading cause in patients s aged 40-60 years. CRAO
what is the treatment for cataracts make an incision (capsulotomy) into the capsule of the cloudy lens in order to surgically remove the lens.
is the most common malignant eye tumor of childhood. One-third of all retinoblastomas are hereditary, which means that RB1 gene mutations are present in all of the body's cells, including reproductive cells retinoblastoma
Created by: moore420