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List of Epilepsy drugs: 1. Benzodiazepines 2. Carbamazepine 3. Ethosuximide 4. Gabapentin 5. Lamotrigine 6. Levetiracetam 7. Phenobarbital 8. Phenytoin, fosphenytoin 9. Tiagabine 10. Topiramate 11. Valproic acid 12. Vigabatrin
What is the main use for Benzodiazepines as an epileptic agent? Acute status epilepticus
What is the mechanism of action of Benzodiazepines? Increase GABA-A action
What epilepsy drugs can be used a secondary treatment of Eclampsia seizures? Benzodiazepines
What are side effects associated with Benzodiazepines? Sedation, tolerance, dependence, and respiratory depression
Which could be the most fatal or severe adverse effect of benzodiazepine overdose? Respiration depression
Which epilepsy drug(s) MOA is to increase the actions GABA-A? Benzodiazepines and Phenobarbital
What is the common use of Carbamazepine? Treatment of Partial (focal) seizures
Which type of generalized seizures can be treated, not commonly, with Carbamazepine? Tonic-clonic seizures
What is MOA of Carbamazepine? Blocks Na+ channels
Which partial seizure medication MOA is to block the sodium cation channels? Cabazempine
List of known adverse effects caused by Carbamazepine? 1. Diplopia 2. Ataxia 3. Blood dyscrasias 4. Liver toxicity 5. Teratogénesis 6. Induction of CYP450 7. SIADH 8. Stevens-Johnson syndrome
What is a severe cutaneous adverse effect of Carbamazepine? Stevens-Johnson syndrome
What are the common blood dyscrasias caused by Carbamazepine? Agranulocytosis and Aplastic anemia
What are the teratogenic side effects associated with the use of Carbamazepine? Cleft lip/palate, and spina bifida
A newborn with cleft lip and palate, and a turf of hair in the lower back, was born to a mother with seizure hx. What is the most likely medication she was taking? Carbamazepine
SIADH, SJS, and blood dyscrasias are known adverse effects of whichani-epilepsy drug? Carbamazepine
What is the 1st line of treatment for Trigeminal neuralgia? Carbamazepine
Besides focal seizures, what non-epileptic condition , is primarily treated with Carbamazepine? Trigeminal neuralgia
What is treated with Ethosuximide? Absence seizure
What drug is used to treat Absence seizures? Ethosuximide
MOA of Ethosuximide Blocks thalamic T-type Ca+ channels
Which anti-epilepsy drug works by blocking the Thalamic T-Type calcium cation channels? Ethosuximide
A list of all adverse effects associated with Ethosuximide: EFGHIJ: - Ethosuximide causes: Fatigue, GI distress, Headache, Itching (and urticaria) Stevens-Johnson syndrome
Thalamic T-type Ca2+ channel blocker epileptic Ethosuximide
Which the only type of seizures treated with Gabapentin? Partial (focal) seizures
What is the MOA of Gabapentin? Primarily inhibits high-voltage-activated Ca2+ channels
Which antiepileptic was designed as a GABA analog? Gabapentin
Inhibition of high-voltage-activated Ca2+ channels. MOA of Gabapentin
Common side effects of Gabapentin Ataxia and Sedation
What are non-epileptic uses of Gabapentin? 1. Peripheral neuropathy 2. Postherpetic neuralgia
Which seizures are can be treated with Lamotrigine? Partial seizures, Tonic-Clonic , and Absence seizures
MOA of Lamotrigine - Blocks voltage-gated Na+ channels - Inhibits the release of glutamate
What NT release is inhibited by Lamotrigine? Glutamate
Which channels are blocked by Lamotrigine? Voltage-gated Na+ channels
What is the associated adverse effect of Lamotrigine? Stevens-Johnson syndrome
How is SJS prevented when taking Lamotrigine? Slow titration
Blocks voltage-gated Na+ channels and inhibits release of glutamate. Mechanism of action of Lamotrigine
What is a possible effect of the mode of action of Levetiracetam? Possible modulation of GABA and glutamate release
What are the adverse effects seen with Levetiracetam? 1. Neuropsychiatric symptoms 2. Fatigue, drowsiness, and headache
Personality changes are seen in a person taking which antiepileptic? Levetiracetam
What is the mode of action of Phenobarbital? Increase GABA-A action
Phenobarbital share MOA with which other type of epilepsy medications? Benzodiazepines
First line of seizures (focal, tonic-clonic) in neonates is: Phenobarbital
What is probably the most severe side effect of Phenobarbital? Cardiorespiratory depression
As side effects, both, benzodiazepines and Phenobarbital have certain organ depressons: Benzodiazepines cause __________________ depression. Phenobarbital causes___________________ depression. Respiratory Cardiorespiratory
Which epilepsy drugs are known to cause induction of the CYP450 system? Carbamazepine and Phenobarbital
1st line of treatment for recurrent status epilepticus Phenytoin
What is Fosphenytoin? Water-soluble phenytoin prodrug used only in hospitals for the treatment of epileptic seizures.
Water-soluble phenytoin Fosphenytoin
What is the mode of action of Phenytoin? Blocks Na+ channels
What is the order kinetics of Phenytoin? Zero
Zero order kinetics antiepileptic Phenytoin
Which antiepileptics or seizure medication block Na+ channels as mechanism of action? Carbamazepine, Phenytoin, and Topiramate
Blocks Na+ channels; zero order kinetics Phenytoin
List of side effects associated with Phenytoin: 1. P450 system induction 2. Hirturism 3. Enlarged gums 4. Nystagmus 5. Yellow-brown skin 6. Teratogenicity 7. Osteopenia 8. Inhibited folate absorption 9. Neuropathy
What rare adverse effects associated with Phenytoin? Stevens-Johnson syndrome, DRESS syndrome, and SLE-like syndrome
Phenytoin is used as 1st line of treatment of acute ----> Tonic-clonic seizures
Phenytoin is used as 1st line of treatment for which recurrent seizure type? Status epilepticus
What is the main agent used for prophylaxis of Status epilepticus? Phenytoin
Phenytoin is an inducer or inhibitor of the CYP450 system? Inducer
Which anti-seizure medication is associated with possible development of SLE-like syndrome? Phenytoin
What is the teratogenic effect caused by Phenytoin? Fetal hydantoin syndrome
A newborn with Fetal Hydantoin syndrome most likely had a mother that took what medication during pregnancy? Phenytoin
What is the common use of Tiagabine? Partial (focal ) seizures
What is the MOA of Tiagabine? Increasing GABA by inhibiting reuptake
MOA- inhibiting GABA reuptake, thus increasing GABA concentration. Tiagabine
What is the mode of action of Topiramate? 1. Blocks Na+ channels 2. Increases GABA action
This drug works by blocking Na+ channels and also by increasing GABA action. Topiramate
Valproic acid is 1st line of treatment of acute -----> Tonic-clonic seizures
What are the two parts of the MOA of Valproic acid? 1. Increases Na+ channel inactivation 2. Increases GABA concentration by inhibiting GABA transaminase
Which enzyme is inhibited by Valproic acid? GABA Transaminase
How does Valproic acid increases the concentration of GABA? Inhibiting GABA transaminase
Which antiepileptic works by Increasing the Na+ channel inactivation? Valproic acid
What are the associated adverse effects of Topiramate? Sedation, mental dulling, word-finding difficulty, kidney stones, weight loss, and glaucoma.
A person with a seizure disorder started to complain about not remembering or finding the right words. She had been an avid writer and poet. What medication can cause this? Topiramate
What is an non-seizure related use of Topiramate? Migraine prevention
What are other uses for Valproic acid, other than as antiepileptic medication? Myoclonic seizures, bipolar disorder, migraine prophylaxis
What teratogenic defects are expected for the use of Valproic acid? Neural tube defects
Irreversible GABA transaminase inhibitor. Vigabatrin
What is the associated black box warning of Vigabatrin? Permanent visual loss
Permanent visual loss may be caused by which antiepileptic? Vigabatrin
What are some common Barbiturates? Phenobarbital, pentobarbital, thiopental, and secobarbital
What is the detailed MOA of Barbiturates? Facilitate GABA-A action by increasing DURATION of Cl- channel opening, thus decreasing neuron firing.
Barbiturates increase or decrease, duration of Cl- opening? Increase
Which type of drugs are known to increase DURATION of Cl-channel opening? Barbiturate
What is the result of the increased duration of Cl- channel opening by Barbiturates? Facilitation of GABA-A action
What are the clinical uses for barbiturates? Sedative for anxiety, seizures, insomnia, induction of anesthesia
Which barbiturate is used as to induce anesthesia? Thiopental
Thiopental is a _____________________. Barbiturate
Increase duration of Cl- channel opening Barbiturate
Barbiturates are to be avoided in people with _________________. Porphyria
A patient with a known porphyria should avoid which type of drugs? Barbiturate
CNS depression by barbiturates can be exacerbated by: Alcohol use
What is the overdose by Barbiturates treatment? Supportive (assist respiration and maintain BP)
List of common Benzodiazepines: Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chlordiazepoxide, Alprazolam
What is the mechanism of action of Benzodiazepines? Facilitate GABA-A action by increasing frequency of Cl- channel opening
Which, benzodiazepines or barbiturates, enhance GABA-A action, by increasing the frequency of Cl- channel opening? Benzodiazepines
Most Benzodiazepines have: Long half-lives and active metabolites
Which mnemonic may be used to remember those Benzodiazepines with SHORT half-lives? ATOM
What does the mnemonic ATOM stands for? Short half-life benzodiazepines Alprazolam, Triazolam, Oxazepam, Midazolam
What is a risk or adverse effect of short half-live benzodiazepines? Higher addictive potential
Which drugs are known to increase the frequency of Cl- channel opening? Benzodiazepines
What drugs and substances bind to GABA-A receptors? Benzodiazepines, Barbiturates, and Alcohol
GABA-A receptor is a : Ligand-gated Cl- channel
Why are Oxazepam, Temazepam, and Lorazepam used to treat alcohol withdrawal safer than other benzodiazepines? Due to minimal first-pass metabolism
What are some important Nonbenzodiazepine hypnotics? Zolpidem, Zaleplon, and esZopiclone
What is the MOA of nonbenzodiazepines hypnotics? Act via BZ1, subtype of GABA receptor
What is the GABA subtype used by nonbenzodiazepine hypnotics? BZ1
Nonbenzodiazepine hypnotic effects are reversible with: Flumazenil
Why are nonbenzodiazepines hypnotics used for sleep? They affect less the sleep cycle as compared to Benzodiazepines
Clinical use for Zolpidem? Insomnia
What is the mechanism of action of Suvorexant? Orexin (hypocretin) receptor antagonist
Orexin receptor antagonist Suvorexant
What is the clinical use for Suvorexant? Insomnia
Suvorexant is contraindicated in patients with _________________. Narcolepsy
What are conditions are have Suvorexant administration contraindicated? 1. Narcolepsy 2. Liver disease 3. Strong CYP3A4 inhibitors
What is the MOA of Ramelteon? Melatonin receptor agonist, binds MT1 and MT2 in suprachiasmatic nucleus.
Ramelteon binds to: MT1 and MT2 in the Suprachiasmatic nucleus
What is the clinical use of Ramelteon? Insomnia
What is the most common Triptan? Sumatriptan
Common 5-HT 1B/1D agonist. Sumatriptan
What is the MOA of Triptans? Inhibit trigeminal nerve activation Prevent vasoactive peptide release Induce vasoconstriction
What is the clinical use for Triptans? - Acute migraine - Cluster headache attacks
What some adverse effects of Triptan therapy? Coronary vasospasm, mild paresthesia, and serotonin syndrome
Which type of patients are at higher risk of coronary vasospasms due to Triptan intake? CAD and/or Prinzmetal angina paites
When is it possible to develop serotonin syndrome with the use of Triptans? When used in combination with other 5-HT agonists.
List of Na+ channel blocker epileptics: 1. Carbamazepine 2. Fosphenytoin 3. Lamotrigine 4. Phenytoin 5. Topiramate 6. Valproic acid
SV2A receptor blocker (antiepileptic). Levetiracetam
List of GABA-A agonists: 1. Benzodiazepines 2. Topiramate 3. Phenobarbital 4. Propofol
Which epileptics are Ca2+ channel blockers? Ethosuximide and Gabapentin
GABA reuptake inhibitor epileptic Tiagabine
Which antiepileptics are GABA transaminase inhibitors? Valproic acid and Vigabatrin
Parkinsonism is due to: Loss of dopaminergic neurons and excess cholinergic activity
Parkinson drugs are categorized in strategies, which are: 1. Dopamine agonists 2. Increase dopamine availability 3. Increase L-DOPA availability 4. Prevent dopamine breakdown 5. Curb excess cholinergic activity
The Dopamine agonists used for Parkinson disease are divided into: 1. Ergot and, 2. Non-ergot
Which type of Dopamine agonist are preferred in treating of Parkinson disease? Non-ergot
Which is the Ergot dopamine agonist used for Parkinson disease? Bromocriptine
What are the Non-ergot dopamine agonists in Parkinson disease treatment? Pramipexole and Ropinirole
Ropinirole and Pramipexole are: Non-ergot Dopamine agonists
What are symptoms are included in Non-ergot dopamine agonist toxicity? Impulse control disorder, postural hypotension, and hallucinations/confusion.
A person with a movement disorder is treated with a commonly used drug for such, but later develops a gambling problem. What are the more likely drugs given? Pramipexole and Ropinirole
Parkinson drug that works by increasing dopamine availability. Amantadine
How does Amantadine increase dopamine availability? Increase dopamine release and decrease dopamine uptake
What are signs of Amantadine toxicity? Ataxia and livedo reticularis
What is the mode of action of drugs that increase L-DOPA availability? Prevent peripheral (pre-BBB) L-DOPA degradation, which increases the L-DOPA entering the CNS ---> increase central L-DOPA available for conversion to dopamine
What are the main drugs that increase L-DOPA availability? Levodopa, Carbidopa, and Entacapone
Levodopa and Entacapone --> Increase L-DOPA availability
MOA of Carbidopa: Blocks peripheral conversion of L-DOPA to dopamine by inhibiting DOPA decarboxylase
Which enzyme is inhibited by Carbidopa? DOPA decarboxylase
How does Entacapone prevent peripheral L-DOPA degradation? Inhibiting COMT
Which drug is used in conjunction with Entacapone? Levodopa
Which enzyme is inhibited by Entacapone? COMT
Peripheral COMT is inhibited by ____________________. Entacapone
Entacapone prevents the degradation of L-DOPA into: 3-O-methyldopa (3-OMD)
A reduction in 3-OMD levels might be seen with the use of which Parkinson disease drug? Entacapone
Agents that inhibit or prevent dopamine breakdown, work pre- or post-BBB? Post-BBB
Which are the two types of agents that prevent dopamine breakdown post-BBB? MAO-B inhibitors and Central COMT inhibitor
A central COMT inhibitor means: It prevents that breakdown of Dopamine post BBB into 3-methoxytyramine (3-MT)
Central or Peripheral COMT inhibitors prevent conversion of dopamine into 3-MT? Central COMT inhibitors
Which is a common central COMT inhibitor used in Parkinson disease? Entacapone
What is the overall purpose of Selegiline and Rasagiline? Prevent dopamine breakdown post-BBB
How does Selegiline prevent Dopamine breakdown? Block conversion of dopamine into DOPAC by selectively inhibiting MAO-B.
Which enzyme is selectively inhibited by selegiline and rasagiline, in the treatment of Parkinson disease? MAO-B
How do MAO-B inhibitors help in treating Parkinson disease symptoms? Prevent dopamine breakdown post-BBB
Which Parkinson drugs are known to curb excess cholinergic activity? Benztropine, trihexyphenidyl
Benztropine and Trihexyphenidyl are ________________________. Antimuscarinics
How do antimuscarinics help in Parkinson symptoms relief? Improve tremors and rigidity but has little to no effect in bradykinesia
What is intended to "better" by the use of Benztropine in Parkinson disease? Tremor and rigidity
What enzyme in the CNS converts L-DOPA into dopamine? DOPA decarboxylase
What long term adverse effects of Levodopa/Carbidopa administration? Dyskinesia following administration ("on-off" phenomenon), akinesia between doses
What is the function of MAO-B? Metabolize dopamine
What is a possible adverse effect of Selegiline and Rasagiline? May enhance adverse effects of L-DOPA
Tetrabenazine and Reserpine clinical uses are: Huntington chorea and Tardive dyskinesia
MOA of Tetrabenazine and reserpine: Inhibit vesicular monoamine transporter (VMAT) dopamine
What is the result of the inhibition of VMAT dopamine? Decrease vesicle packaging and release
Which drugs may cause decrease vesicle packaging and release due to VMAT dopamine inhibition? Tetrabenazine and reserpine
What is the use for Riluzole? ALS
MOA of Riluzole? Decreased neuron glutamate excitotoxicity
What medication is used to treat Lou Gehrig disease? Riluzole
List of common Alzheimer drugs: 1. Memantine 2. Donepezil, Rivastigmine, and Galantamine
What is the mechanism of action of Memantine? NMDA receptor antagonist
NMDA receptor antagonist used to treat Alzheimer? Memantine
What are the two types of Alzheimer disease drugs? 1. NMDA receptor antagonists 2. AChE inhibitors
CNS drugs must be: 1. Lipid soluble, in order to cross the BBB, or, 2. Actively transported across the BBB
Drugs with low solubility in blood = Rapid induction and recovery times
Drugs with high solubility in lipids = Increase in potency
1 -------------- = MAC Potency
What does MAC in anesthetics stand for? Minimal Alveolar Concentration
What is MAC? Minimal Alveolar Concentration required to prevent 50% of subjects from moving in response to noxious stimulus
Which anesthetic is an example of decreased blood and lipid solubility? Nitrous oxide (N2O)
Halothane, propofol, and thiopental have: Increase lipid and blood solubility, and thus high potency and slow induction.
Which anesthetics have high potency and slow induction? Halothane, propofol, and thiopental
What are inhaled anesthetics examples? Desflurane, halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, and N2O.
What are the physiological effects of inhaled anesthetics? Myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow.
Halothane adverse effect Hepatotoxicity
What adverse effect is seen with Methoxyflurane? Nephrotoxicity
Which inhaled anesthetics are proconvulsant if toxic levels are reached? Enflurane and Epileptogenic
What is a possible adverse effect of the use of N2O as an inhaled anesthetic? Expansion of trapped gas in a body cavity
What is Malignant hyperthermia? Rare, life-threatening condition in which inhaled anesthetics or succinylcholine induce fever and severe muscle contractions.
What are the genetic principles associated with Malignant hyperthermia? The susceptibility of Malignant hyperthermia, is often inherited as AD with variable penetrance.
What type of mutations induced or cause increase levels of Ca2+ release from Sarcoplasmic Reticulum? Voltage-sensitive Ryanodine receptor (RYR1 gene) mutations
A mutated RYR1 gene causes --> Increase release of Ca2+ from SR
A mutated RYR1 gene may increase the subject's susceptibility to develop which anesthetic-induced emergency? Malignant hyperthermia
What is the treatment for Malignant hyperthermia? Dantrolene
Dantrolene is used to treat: Malignant hyperthermia
A person under surgery spikes fever > 104 F and has muscle twitches, is going to be treated with: Dantrolene
What is the MOA of Dantrolene? Ryanodine receptor antagonist
Ryanodine receptor antagonist Dantrolene
Is malignant hyperthermia associated with Intravenous (IV) or Inhaled anesthetics? Inhaled anesthetics
What are the common Intravenous anesthetics? Thiopental, Midazolam, Propofol, and Ketamine
Thiopental is a _______________________ anesthetic. Intravenous anesthetic
Which IV anesthetic is a barbiturate? Thiopental
Which IV anesthetic is a Benzodiazepine? Midazolam
NMDA receptor antagonist IV anesthetic Ketamine
What is the mode of action of Propofol? Pontentiates GABA-A
Which GABA receptor type, is targeted by IV anesthetics, A or B? GABA-A
Thiopental is used for long or short, surgical procedures? Short
How is the effect of Thiopental quickly terminated? Rapid redistribution into tissue and fat
Cerebral blood flow with Thiopental is increased or decreased? Decreased
Which IV anesthetic decreases cerebral blood flow? Thiopental
What are severe or significant adverse effects of IV anesthetic, Midazolam? Severe postoperative respiratory depression, hypotension, and anterograde amnesia
What kind of amnesia may be provoked as adverse effect of Midazolam? Anterograde amnesia
What are the common uses for Midazolam? 1. Procedural sedation (endoscopy) 2. Anesthesia induction
Which IV anesthetic may be used in the ICU setting? Propofol
Which IV anesthetic is used to rapid anesthesia induction? Propofol
MOA of Ketamine NMDA receptor antagonist
What are the anesthetic uses of Ketamine? 1. Dissociative anesthesia 2. Sympathomimetic
Increased or Decreased. Cerebral blood flow with Ketamine? Increased
What is a possible emergence reaction to Ketamine anesthesia? Disorientation, hallucination, and vivid dreams
Which IV anesthetic is known to increase the cerebral blood flow? Ketamine
What are the two types of local anesthetics? Esters and Amides
List of Ester Local anesthetics: Procaine, Tetracaine, Benzocaine, and Chloroprocaine
List of Amide Local anesthetics: Lidocaine, Mepivacaine, Bupivacaine, and Ropivacaine
What is the MOA of Local anesthetics? Block Na+ channels by dingin to specific receptors on inner portion of channels
On which neuros a local anesthetics the most effective? Rapidly firing neurons
What can be given along with a local anesthetic to enhance the local action? Epinephrine
How does the co administration of local anesthetic + epinephrine help to enhance effect? Decrease bleeding, increase anesthesia by systemic concentration
What is the order of loss when a local anesthetic is administered? Pain --> Temperature --> Touch --> Pressure
What is the first scenario that is loss or blocked by local anaesthetics? Pain
What type of anesthetics are used for spinal anesthesia? Local anesthetics
What is an bupivacaine specific adverse effect? Cardiovascular toxicity
Which local anesthetic is known to cause Methemoglobinemia? Benzocaine
Selective for Nm nicotinic receptors at NMJ but not autonomic Nn receptors. Neuromuscular blocking drugs
Neuromuscular blocking drugs are divided into ________________ and _________________. Depolarizing and Non-depolarizing
What are complications of Depolarizing neuromuscular blocking drugs? Hypercalcemia, hyperkalemia, and malignant hyperthermia.
What is the most common Depolarizing neuromuscular blocking agent? Succinylcholine
Succinylcholine is a strong___________________________________. ACh receptor agonist
MOA of Succinylcholine: ACh receptor agonist that produces sustained depolarizing and prevents muscle contraction
The reversal of blockade caused by Succinylcholine is reversed in how many phases? 2 phases
Which phase pf Succinylcholine blockade is definced a prolonged depolarization? Phase I
Phase II of Succinylcholine blocked is: Repolarized but blocked; ACh receptors are available, but desentized
What some common Nondepolarizing Neuromuscular blocking drugs? Atracurium, Cisatracurium, Pancuronium, and Vecuronium
What is MOA of Non-depoloarizing nuromulsclar blcking agents? Competitive with ACh for receptors
What are some drugs used to reverse the Nondepolarizing neuromuscular drug blockade? Neostigmine and Edrophonium
Why is neostigmine must be given with atropine or glycopyrrolate? To prevent muscarinic effects such as bradycardia
Which drugs must be administered with Neostigmine in order to prevent muscarinic effects? Atropine or Glycopyrrolate
_______________________, prevents the release of Ca2+ from the SR of skeletal muscle by binding to the ryanodine receptor. Dantrolene
What are the two clinical sues for Dantrolene? 1. Malignant hyperthermia, 2. Neuroleptic malignant syndrome
What is a severe toxicity of antipsychotic drugs treated with Dantrolene? Neuroleptic malignant syndrome
MOA of Baclofen: Skeletal muscle relaxant. GABA-B receptor agonist in spinal cord
What is the clinical use for Baclofen? Muscle spasticity, dystonia, and multiple sclerosis
GABA-B receptor agonist in spinal cord Baclofen
Which GABA receptor is used by Baclofen? GABA-B
Skeletal muscle relaxant that acts within CNS Cyclobenzaprine
What is the clinical use for Cyclobenzaprine? Muscle spasms
List of antispasmodics or Spasmolytics: - Baclofen - Cyclobenzaprine - Dantrolene - Tizanidine
What is the mechanism of action of Tizanidine? a-2 agonist, acts centrally
What conditions which produce spams, are treated with Tizanidine? Muscle spasticity, multiple sclerosis, ALS, and cerebral palsy
Which spasmolytics work centrally? Cyclobenzaprine and Tizanidine
Back muscle pain/spasm is commonly treated with: Baclofen
On which opioid receptors does opioid analgesics work? u, g, and k
Which is the B-endorphin opioid receptor? u
What is mechanism of action of opioid analgesics? Agonists at opioid receptors to modulate synaptic transmission, which leads to closure of presynaptic Ca2+ channels and open K+ channels leading to a decrease in synaptic transmission.
What are common Opioid analgesics Full agonists? Morphine, heroin, meperidine, methadone, codeine, and fentanyl
Which is a common Opioid analgesics Partial agonist? Buprenorphine
Mixed agonist/antagonist opioid analgesics? Nalbuphine, pentazocine, and butorphanol
Common Opioid analgesics antagonists Naloxone, naltrexone, and methylnaltrexone
Clinical uses for Opioid analgesics: - Moderate to severe or refractory pain - Diarrhea - Acute pulmonary edema - Maintenance programs for heroin addicts
Which opioid analgesics are used for maintenance programs for heroin addicts? Methadone, buprenorphine + naloxone
What are some adverse effects of opioid analgesics? N/V, pruritus, addiction, respiratory depression, constipation, sphincter of Oddi spasms, miosis, additive CNS depression with other drugs
What is used to treat Opioid analgesic toxicity? Naloxone
What is used to treat relapse of a detoxified Opioid analgesic? Naltrexone
What are the two common Mixed and antagonist opioid analgesics? Pentazocine and Butorphanol
What is the mechanism of action of PENTAZOCINE? 1. k-opioid receptor agonist and , - u-opioid receptor weak antagonist or partial agonist
What is the clinical use for Pentazocine? Analgesia for moderate to severe pain
What is a severe adverse effect or result from the use of Pentazocine? Opioid withdrawal symptoms if patient is also taking full opioid agonist.
What are the mechanisms of action of Butorphanol? 1. k-opioid receptor agonist and, 2. u-opioid receptor partial agonist
What are common instances in which Butorphanol is used? In severe pain such as migraines and labor.
What is the MOA of Tramadol? Very weak opioid agonist
Which opioid analgesic is known to inhibit the reuptake of norepinephrine and epinephrine? Tramadol
Very weak opioid agonist Tramadol
What is the use for Tramadol? Chronic pain
What are two specifics adverse effects of Tramadol? - Decreases seizure threshold - Serotonin syndrome
What is the purpose of Glaucoma therapy? Decreases IOP via decreased amount of aqueous humor
How is the aqueous humor decreased in Glaucoma therapy? Inhibition of synthesis/ secretion or increase drainage of aqueous humor.
Which drug classes are in Glaucoma therapy are used to decrease aqueous humor synthesis? B-blockers, a-agonists, and diuretics.
Which beta-blockers are used in Glaucoma? Timolol, betaxolol, and carteolol
How do beta-blockers mechanism of action work for Glaucoma treatment? Decreases aqueous humor synthesis
Which are common alpha-agonists used in Glaucoma therapy? Epinephrine, apraclonidine, and Brimonidine
Decreases aqueous humor synthesis via vasoconstriction. Epinephrine
Which a-agonist is contraindicated in treatment of closed-angle glaucoma? Epinephrine
What is an adverse effect of Epinephrine in association of Glaucoma treatment? Mydriasis
What are the adverse effects seen with Apraclonidine and Brimonidine, as they treat glaucoma? Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, and ocular pruritus.
Which a common diuretic used for Glaucoma? Acetazolamide
How does Acetazolamide help in treating glaucoma? Decreases aqueous humor synthesis via inhibiting carbonic anhydrase
Which common prostaglandins are used in treating Glaucoma? Bimatoprost, and Latanoprost
How do Prostaglandins MOA contribute to Glaucoma treatment? 1. Increase outflow of aqueous humor via a decreaed resistace of flow through uveoscleral pathway
What are adverse effects of Glaucoma treating Prostaglandins? 1. Darkens color of iris (browning) 2. Eyelash growth
Direct Cholinomimetics that are used to treat Glaucoma: Pilocarpine and Carbachol
Pilocarpine and Carbachol are: Direct cholinomimetics that are used to treat glaucoma
Which receptor are the cholinomimetics use to treat glaucoma? M3
Which are the Indirect cholinomimetics that treat glaucoma? Physostigmine and Echothiophate
MOA of Cholinomimetics treating Glaucoma: Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
Why is Pilocarpine widely used in Closed-angle glaucoma? Very effective at opening meshwork into canal of Schlemm
Which cholinomimetic is very effective in treatment of Closed-angle glaucoma? Pilocarpine
What are the two main adverse effects of Glaucoma-treating cholinomimetics? Miosis and cyclospasm
What causes the cyclospasms when using Cholinomimetics to treat glaucoma? Contraction of ciliary muscle
Which muscle is stimulated to contract in order for cholinomimetics to treat Glaucoma? Ciliary muscle
Which Glaucoma therapy drug classes work by increasing the outflow of aqueous humor? Prostaglandins and Cholinomimetics (M3)
List of structures that are located in the Anterior segment of the eye: 1. Ciliary body 2. Zonular fibers 3. Cornea 4. Iris 5. Pupil 6. Lens 7. Anterior chamber 8. Posterior chamber
What structure covers the whole eye? Sclera
List of structures that are in the Posterior segment of the eye? 1. Sclera 2. Choroid 3. Retina 4. Fovea 5. Optic disc 6. Central retinal artery and vein 7. Optic nerve 8. Vitreous chamber
Anterior chamber + Posterior chamber = Anterior segment
In the posterior segment of the eye, what is the outermost structure? Sclera
In the posterior segment of the eye, what is the middle and inner structures? - Choroid (middle) - Retina (inner)
The iris, is the _______________ structure of the anterior segment of the eye. Middle
What is Conjunctivitis? Inflammation of the conjunctiva causing red eye
Clinical presentation of Allergic Conjunctivitis? Itchy eyes, and bilateral
What are the clinical features of Bacterial conjunctivitis? Pus; treatment with antibiotics
Pus in conjunctivitis most likely points to allergic, bacterial, or viral etiology? Bacterial
What are the 3 main etiologies for Conjunctivitis? Allergic, bacterial, and viral
What the most common type or etiology for Conjunctivitis? Viral conjunctivitis
What is the most common viral pathogen that causes conjunctivitis? Adenovirus
Clinical profile of viral conjunctivitis: Sparse mucous discharge, swollen preauricular node; self-resolving
Which type of conjunctivitis is often seen with preauricular node involvement? Viral conjunctivitis
List of REFRACTIVE errors: 1. Hyperopia 2. Myopia 3. Astigmatism 4. Presbyopia
What do Refractive errors mean? Means that the shape of your eye does not bend light correctly, resulting in a blurred image
What is a common cause of impaired vision, but corrected with eyeglasses? Refractive errors
What is the common name for Hyperopia? Farsightedness
What is the cause of Hyperopia? Eye too short for refractive power of cornea and lens which causes the light to focus behind the retina.
Where do light focuses in Hyperopia, in front or behind the retina? Behind retina
What type of lenses are used to correct hyperopia? Convex (converging) lenses
Convex (converging) lenses are used to correct what type of refractive error? Hyperopia
Eye to short or small for refractive power of cornea and lens. Hyperopia
Light focused behind the retina. Dx? Hyperopia
What is the common name for Myopia? Nearsightedness
Nearsightedness = Myopia
Farsightedness = Hyperopia
What is the problem with Myopia? Eye too long for refractive power of cornea and lens leading to light focused in front of retina
If the light is focused in front of retina. Dx? Myopia
In myopia, the light is focused in front or behind the retina? In front retina
Eye to long for refractive power of cornea and lens. Myopia
What type of lenses are used to correct Myopia? Concave (diverging) lens
A concave (diverging) lens is used to correct which refractive error? Myopia
Abnormal curvature of the cornea. Dx? Astigmatism
What is the result of abnormal curvature of the cornea? Different refractive power at different axes
Which refractive error (condition) is characterized by having different refractive powers at different angles? Astigmatism
What type of lens are used in Astigmatism? Cylindrical lens
Cylindrical lens correct which refractive error? Astigmatism
What is astigmatism? Abnormal curvature of cornea leading to different refractory power at different angles.
A person with Astigmatism should buy eyeglasses with what type of lens? Cylindrical lens
What is Presbyopia? Aging-related impaired accommodation, primarily due to decreased lens elasticity, changes in lens curvature, decreased strength of ciliary muscle
Which is the age related refractive error? Presbyopia
What type of glasses are used in Presbyopia patients? "Reading glasses" (magnifiers)
What refractive error is due to impaired accommodation of the eyesight? Presbyopia
77 year old man with difficulty focusing on near objects. Dx? Presbyopia
Which muscle usually looses its normal strength in Presbyopia? Ciliary muscle
Eye inspection reveal a decrease in lens elasticity, changes in curvature of lens, and a weakening ciliary muscle. What is the most likely refractive error? Presbyopia
Aging-related impaired accommodation. Dx? Presbyopia
Common vision condition in which you can see distant objects clearly, but objects nearby may be blurry Hyperopia
A "farsighted" describes his/her sight as: Can see objects far away, but see blurry objects nearby
A "nearsighted" person would say that his/her vision is: Can see objects nearby, but sees blurry or difficulty when objects are far away.
A person with Myopia cannot see objects that are __________. Far away
A person with Hyperopia cannot see objects that are ____________. Nearby
What is a Cataract? Painless, often bilateral, opacification of lens, often resulting in glare and decreased vision, especially at night
Painless, bilateral, opacification of the lens leading to poor vision at night. Dx? Cataracts
What known risk factor for Cataracts? Increasing age Smoking Excessive alcohol use Excessive sunlight Prolonged corticosteroid use Diabetes mellitus
Which "blood sugar" condition is associated with development of cataracts? Diabetes mellitus
List of congenital risk factors/ conditions that increase chances of developing Cataracts: 1. Classic Galactosemia 2. Galactokinase deficiency 3. Trisomies (13, 18, 21) 4. TORCHES infections (rubella) 5. Marfan syndrome 6. Alport syndrome 7. Myotonic dystrophy 8. Neurofibromatosis 2
Which type of NF is associated with Cataracts? Neurofibromatosis 2
Which TORCHES infection is especially associated with development of cataracts? Rubella
Which saccharide metabolic conditions are associated with development fo Cataracts? Galactose metabolism
Which canal is used by the Aqueous humor in Trabecular outflow pathway? Canal of Schlemm
What type of medication is used to increase the Trabecular outflow? M3 agonist
Drainage of aqueous humor into uvea and sclera is known as: Uveoscleral outflow
What produces the Aqueous humor? Nonpigmented epithelium on ciliary body
Which type of drugs or medications are used to decrease the production of Aqueous humor? B-blockers, a2-agonists, and carbonic anhydrase inhibitors
What is the role of Muscular fibers in ciliary body? Affect lens shape for accomodation
What eyesight function can be deficient in case of damage to the muscular fibers in ciliary body? Accomodation
What is Glaucoma? Optic disc atrophy with characteristic cupping, usually with elevated intraocular pressure (IOP) and progressive peripheral visual field loss if untreated
What is the ultimate purpose of Glaucoma treatment? Lowering IOP with medications or surgically
What is "cupping" when used in association with Glaucoma? Thinning of outer rim of optic nerve head versus normal
Thinning of outer rim of optic disc and increased IOP. Dx? Glaucoma
What are the types of Glaucoma? 1. Open-angle glaucoma 2. Closed- or Narrow-angle glaucoma
What is the main associated in develop of Open-angle glaucoma? Increasing age, African-American, and family history
Which type of Glaucoma is most common in the USA? Open-angle glaucoma
What is the cause of Secondary Open-angle glaucoma? Due to blocked Trabecular meshwork from WBCs, RBCs, and/or retinal elements
What condition can lead to secondary open-angle glaucoma due to blockage of meshworkby WBCss? Uveitis
What is a possible consequence or resulting pathology of a vitreous hemorrhage? Secondary Open-angle glaucoma
Retinal detachment can led to what type of Glaucoma? Secondary Open-angle glaucoma
Blockage of trabecular meshwork General cause of Secondary Open-angle glaucoma
What is primary Closed (narrow)-angle glaucoma? Enlargement or anterior movement of lens against central iris leading to obstruction of normal aqueous flow through pupil.
What is the result of the blockage of aqueous humor flow in primary Closed angle glaucoma? Fluid builds up behind iris, pushing peripheral iris against cornea and impeding aqueous flow through trabecular meshwork
What part of the eye is either enlarged or moved anteriorly that lead to the development of Primary Closed (Narrow) angle glaucoma? Lens against central iris
What is the cause for Secondary Closed (Narrow) angle glaucoma? Hypoxia from disease induces vasoproliferative in iris that contacts angle
How does DM can cause Narrow-angle glaucoma? It causes hypoxia, which as result induces the vasoproliferation in the iris that contracts the angle.
What is "Chronic closure" in Closed-angle glaucoma referred to? Often asymptomatic with damage to optic nerve and peripheral vision
Which is a true ophthalmic emergency, acute or chronic closure, in Closed-angle glaucoma? Acute closure
What are the symptoms seen in Acute closure in Closed angle glaucoma? Very painful, red eye, sudden vision loss, ahos around lights, frontal headache, fixed and mid-dilated pupil.
What type of agents are contraindicated in Acute closure? Mydriatic agents
What causes Acute closure in Closed angle Glaucoma? Elevated IOP pushes iris foard leading to angle to close up abruptly.
What condition is suspected in diabetic mellitus patient, that has suddenly lost vision in right eye, complains of a headache, and indicates alot of pain in the right eye? Acute closure in Closed angle glaucoma
What is Uveitis? Inflammation of the uvea
What determines the specific name for uveitis type? Location within affected eye
What are the types of uveitis? Anterior uveitis, iritis, and posterior uveitis.
What is hypopyon? Accumulation of pus in anterior chamber
What ocular condition is associated with Hypopyon? Uveitis
What are associated symptoms along with Uveitis? Hypopyon and conjunctival redness
What are common systemic inflammatory disorders associated with Uveitis? Sarcoidosis, rheumatoid arthritis, juvenile idiopathic arthritis, HLA-B27-associated conditions.
What is and causes Age-related macular degeneration? Degeneration of macula (central ara of retina), and causes distortion and eventual loss of central vision.
What causes loss of central vision in Age-related macular degeneration? Scotomas
What are the two types of age-related macular degeneration? Dry and Wet
Description of Dry macular degeneration due to age. Deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium with gradual decreaes in vision
Non-exudative macular degeneration is another way to refer to: Dry macular degeneration
What the simpler form to refer to Exudative age-related macular degeneration? Wet macular degeneration
Rapid loss of vision due to bleeding secondary to choroidal neovascularization. Wet macular degeneration
What is the treatment to prevent progression of age-related dry macular degeneration? Multivitamins and antioxidant supplements
What is used to treat Age-related wet macular degeneration? Anti-VEGF injections
What are some examples of anti-VEGF injections? Bevacizumab and Ranibizumab
What is retinal damage due to chronic hyperglycemia? Diabetic retinopathy
Diabetic retinopathy has two forms: 1. Nonproliferative 2. Proliferative
How does Nonproliferative Diabetic retinopathy develops? Due to damaged capillaries leak blood leading to lipids and fluid seep into retina causing hemorrhages and macular edema
What is the best treatment and/or management for Nonproliferative Diabetic retinopathy? Blood sugar control
What is the result of the damaged capillaries in nonproliferative diabetic retinopathy? Leak blood which lead to lipids and fluids to reach the retina causing hemorrhages and macular edema
What causes Proliferative Diabetic retinopathy? Chronic hypoxia
Chronic hypoxia is the major cause for which type of Diabetic retinopathy? Proliferative Diabetic retinopathy
What is the result of chronic hypoxia causing proliferative diabetic retinopathy? New blood vessel formation with resultant traction on retina
What is the treatment for proliferative diabetic retinopathy? Peripheral retinal photocoagulation, surgery, and anti-VEGF.
Which condition is known to be treated with Peripheral Retinal Photocoagulation? Proliferative Diabetic retinopathy
Retinal damage due to chronic uncontrolled HTN Hypertensive retinopathy
What ophthalmologic condition is associated with Flame-shaped retinal hemorrhages? Hypertensive retinopathy
Clinical features of Hypertensive Retinopathy 1. Flame-shaped retinal hemorrhages 2. Arteriovenous nicking 3. Microaneurysms 4. Macular star 5. Cotton-wool spots
Cotton-wool spots + Macular star + Flamed-shaped retinal hemorrhages. Dx? Hypertensive retinopathy
What associated symptom if present in Hypertensive retinopathy, requires immediate lowering of the blood pressure? Papilledema
What conditions are often associated with Hypertensive retinopathy? 1. Increase risk of stroke 2. CAD 3. Kidney disease
A person with BP 190/112, that has not visited a physician in 20 years, and indicates some problems with sight. Dx? Hypertensive retinopathy
Blockage of central or branch retinal vein due to compression from nearby arterial atherosclerosis. Retinal vein occlusion
"blood and thunder appearance" in fundoscopy is often used in describing what ophthalmologic pathology? Retinal vein occlusion
What is a more common way to refer to the retinal hemorrhage and venous engorgement seen in retinal vein occlusion? "blood and thunder appearance"
What are the clinical features of Retinal vein occlusion? 1. Retinal hemorrhage and vein engorgement 2. Edema in affected area
What is Retinal vein occlusion? The blockage of central or branch of the Retinal vein due to the compression from nearby arterial atherosclerosis.
What is the most common cause of blocking the central retinal vein or a branch of such vein? Compression by nearby arterial atherosclerosis
What is Retinal detachment? Separation of neurosensory layer of retina from outermost pigmented epithelium leading to degeneration of photoreceptors and eventually vision loss
Which parts of the eye anatomy are "detached" in Retinal detachment? The neurosensory layer of the retina, form the outermost pigmented epithelium
What is degenerated by the detachment of the retina layer and the outermost pigmented epithelium, in Reitan detachment? Photoreceptors
What is the results or degeneration of photoreceptors in Retinal detachment? Vision loss
What are some secondary etiologies for Retinal detachment? - Retinal breaks - Diabetic tration - Inflammatory effusions
What are the fundoscopic findings in Retinal detachment? Crinkling of retinal tissue and changes in vessel direction
Retinal breaks, which cause retinal detachment are more common in: Patients with high myopia and/or history of head trauma
What are common used words to describe the Posterior vitreous detachment which often precedes Retinal detachment? "Flashes" and "floaters"
What are key features or symptoms seen in Retinal detachment? 1. Posterior vitreous detachment 2. Monocular loss of vision
How is the loss in vision in Retinal detachment described? - Monocular loss - Like "curtain drawn down"
A patient complains of unable to see from right eye, and describes it as a "curtain been drawn down" and indicate prior to losing vision, he could "feel and see" floaters in the right eye. Dx? Right eye Retinal detachment
How is the progress and vision loss in Central Retinal artery occlusion? Acute, painless monocular vision loss
Retinal cloudy with attenuated vessels and "cherry-red" spot at fovea. Dx? Central Retinal artery occlusion
Which is most common, Central Retinal artery or Central Retinal vein, occlusion? Central Retinal vein occlusion
Which is more severe, Central Retinal artery or Central Retinal vein, occlusion? Central Retinal artery occlusion
Which most likely to occur, an occlusion of the Central Retinal vein or Branch Retinal vein? Branch Retinal vein occlusion
In which Central Retinal vessel occlusion, is a "cherry-red" spot at the fovea seen? Central Retinal artery occlusion
What is the first thing to evaluate in cases of suspected Central Retinal artery occlusion? Embolic source
What are common conditions that predispose for Central Retinal artery occlusion? Embolic-inducing conditions such as: Carotid Artery atherosclerosis, Cardiac vegetations, and PFO.
Clinical presentation of Central Retinal artery occlusion (CRAO)? - Sudden, profound vision loss - Painless - Monocular
Clinical presentation of Central Retinal vein occlusion (CRVO)? - Blurred vision to sudden vision loss - Painless - Monocular
Is vision loss in CRAO and CRVO, painful or painless? Painless
Common etiologies for CRAO: 1. Embolism 2. Vasculitis 3. Vasospasm 4. Sickle cell 5. Trauma 6. Glaucoma
Common etiologies for CRVO: Hypercoagulable states, stokes, glaucoma, and compression of vein by thyroid or ocular tumors
Optic disc edema + Diffuse retinal hemorrhages. Dx? Central Retinal vein occlusion
Retinal pallor, Macular "cherry-red" spot + Afferent pupillary defect. Dx? Central Retinal artery occlusion
What is inherited retinal degeneration disorder? Retinitis pigmentosa
What is Retinitis pigmentosa? Inherited retinal degeneration. - Painless, progressive vision loss beginning with night blindness.
Progressive, painless vision loss that starts by losing vision at night. Dx? Retinitis pigmentosa
What are the features findings in Macular of Retinitis pigmentosa? Bone spicule-shaped deposits around macula
Finding; Bone spicule-shaped deposits around macula. Dx? Retinitis pigmentosa
Which cells are affected first in Retinitis pigmentosa? Rods
Early in Retinitis pigmentosa, are the rods or cones affected first? Rods
What is the definition for Retinitis? Retinal edema and necrosis leading to scar
What are the common viral pathogens that cause Retinitis? CMV, HSV, VZV
What condition is often associated or seen with Retinitis? Immunosuppression
What is Papilledema? Optic disc swelling (usually bilateral) due increased ICP
Enlarged blind spot and elevated optic disc with blurred margins. Dx? Papilledema
What is the most characteristic fundoscopic finding in Papilledema? Elevated Optic disc with blurred margins
What ocular condition is often seen with enlarged blind spot, and optic disc swelling? Papilledema
What are the three actions or functions of the eye that compose Pupillary control? 1. Miosis 2. Pupillary light reflex 3. Mydriasis
Pupillary constriction is referred as __________________. Miosis
Miosis is it controlled by the Parasympathetic or sympathetic system? Parasympathetic
How many neurons make up the process of Miosis? 2 neurons
What is connected by the 1st Neuron in Miosis? Edinger-Westphal nucleus to ciliary ganglion via CN III
What is the role or connection of the 2nd Neuron in Miosis? Short ciliary nerves to sphincter pupillae muscles
Medical term to "make pupil small" Miosis
In testing the Pupillary light reflex, the light shone at either eye, sends signal to Pretectal nuclei via which cranial nerve? CN II
Light going INTO the eye is transmitted to the LGN and Edinger-Westphal nucleus via the : CN II
Once the light signal transmitted by CN II reaches the Pretectal nuclei in the midbrain it: Activates bilateral Edinger-Westphal nuclei
The bilateral activation of the Edinger-Westphal nuclei causes: Pupils constrict bilaterally
If the Light reflex on either eye, cause pupil contsticiton in boeth eyes, it is: Positive (non affected) Direct and consensual reflex
A positive Direct and Consensual reflex in Pupillary light reflex means: Both pupils constrict when light is shone to one eye
What is the expected (healthy) result for Pupillary light reflex? Illumination of 1 eye result in blagearl pupillary constriction
Mydriasis is: Sympathetic dilation of the pupil
How many neurons are involved in Mydriasis? 3 neurons
What is "connected" by the 1st neuron of Mydriasis? Hypothalamus to Ciliospinal center of Budge (C8-T2)
Where is the Pretectal nuclei? Midbrain
In which pupillary function is the Ciliospinal center of Budge involved with? Mydriasis 1st neuron
Where in the spinal cord is the ciliospinal center of Budge usually located? C8-T2
Where does the 2nd neuron of Mydriasis exits the spinal cord? At T1
Exit at T1 and travels to superior cervical ganglion 2nd neuron of Mydriasis
What is the course followed by the 2nd neuron of Mydriasis? Travels along cervical sympathetic chain near lung apex, and subclavian vessels
What is the course or path of the 3rd neuron involved in Mydriasis? Plexus along internal carotid, through cavernous sinus; enter orbit as long ciliary nerve to pupillary dilator muscles
What do the sympathetic fibers of the 3rd neuron in mydriasis innervate? Smooth muscle of eyelids and sweat glands of forehead and face
What is Marcus Gunn pupil? When light shine into a normal eye, the pupillary reflex is intact, but when shown to the affected eye, both pupils dilate instead of constrict.
A "reverse" result in Pupillary light reflex? Marcus Gunn pupil
What causes the abnormal Pupillary reflex that leads to Marcus Gunn pupil? Impaired conduction of light signal along the injured optic nerve
What is the Direct reflex part of the Pupillary light reflex? Constriction of the Ipsilateral eye
What is the Consensual reflex part of the Pupillary light reflex? Constriction of the contralateral eye
What are the main symptoms of Horner syndrome? 1. Ptosis 2. Anhidrosis 3. Miosis
What is Ptosis? Slight drooping of eyelid
What muscle is associated with Ptosis? Superior tarsal muscle
Horner syndrome is: Sympathetic denervation of the face
Medical term for absence of sweating? Anhidrosis
Horner syndrome is associated with a sympathetic chain composed of how many neurons? 3 neurons
What are the lesions associated with 1st neuron associated with Horner syndrome? - Pontine hemorrhage - Lateral medullary syndrome - Spinal cord lesion above T1
What is the condition that is known to cause Horner syndrome at the level of the 2nd neuron? Pancoast tumor
What condition may lead to Horner syndrome due to 3rd neuron lesion? Carotid dissection
What are common spinal cord lesion above T1 that cause Horner syndrome? Brown-Sequard syndrome and Late-stage syringomyelia
Which condition is seen with Ptosis, Anhidrosis, and Miosis? Horner syndrome
Where is the synapse of the first and second neuron in Horner syndrome sympathetic chain? Lateral horn
Where or which structure locates the synapse between the second and third neuron in Horner syndrome? Superior cervical ganglion
At what point of spinal cord is the Superior Cervical ganglion? C2
What what level of the spinal cord is the second synapse in Horner syndrome sympathetic chain? T1
Which arterial bodies are in proximity to the 3rd neuron of Horner syndrome? Internal and External Carotid artery
List of Ocular motility muscles: 1. Superior Rectus muscle 2. Lateral Rectus muscle 3. Inferior Oblique muscle 4. Superior Oblique muscle 5. Medial Rectus muscle 6. Inferior Rectus muscle
Which ocular motility muscle is innervated by cranial nerve VI? Lateral rectus muscle
Which ocular motility muscle ins innervated by CN IV? Superior oblique muscle
What is the mnemonic to depict the all the ocular motility cranial nerve innervation? LR6 SO4 R3
What is the strongest action of the Superior Oblique muscle? Depression when the eye is adducted
In ocular muscles, the "obliques" go: Opposite side
If patient is looking to the right, which ocular muscles are been tested? Left SO and Left IO
How is the patient asked to look in order to test the Inferior Oblique muscle? Up
What are common causes of CN III damage? 1. Ischemia --> pupil sparring 2. Uncal herniation --> coma 3. PCA aneurysm --> sudden-onset headache 4. Cavernous sinus thrombosis --> proptosis, involvement of CNs IV, V1/V2, VI 5. Midbrain stroke --> contralateral hemiplegia
What type of pathology affects in CN III damage, affects most the motor output to extraocular muscles? Vascular disease due to decreased diffusion of oxygen and nutrients to the inferior fibers form compromised vasculature that reside on outside of nerve.
What are the CN III palsy deficits due to vascular disease? Ptosis, "down and out" gaze
What are the two main components of CN III? Motor (central) and Parasympathetic (peripheral)
What affects the parasympathetic component in CN III damage? Compression by PCom aneurysm or Uncal herniation
What are the signs seen by Parasympathetic (peripheral ) CN III damage? 1. Diminished or absent Pupillary light reflexes 2. "blown pupil" often with "down-and-out" gaze
What type of gaze is seen in CN III palsy? Down and Out
Eyes move upward, particularly with contralateral gaze. Dx? CN IV palsy
How does one can easily distinguish CN IV palsy in a person by non-ocular signs? Going down stairs, head may tilf in the opposite direction to compensate
Cranial Nerve VI damage (palsy) is defined as: Affected eye unable to abduct and is displaced medially in primary position of gaze
Which ocular palsy is characterized by inability to abduct affected eye? CN VI palsy
What condition is suspected if a person can abduct eye, and instead it is "maintained" at primary position (medial) of gaze? CN VI palsy
Ask patient "look to the left" and the patient immediately has upward eye deviation. Dx? Right sided CN IV palsy
List of Visual field defects: 1. Right/Left anopia 2. Bitemporal hemianopia 3. R/L homonymous hemianopia 4. R/L Upper quadrantanopia 5. R/L lower quadrantanopia 6. R/L hemianopia with macular sparing 7. Central Scotoma
Which conditions can cause Bitemporal hemianopia? Pituitary lesion and compression of Pituitary chiasm
A left upper quadrantanopia is most likely due to: Left temporal lesion or MCA lesion
A right parietal lesion may me responsible for which visual field defect? Left lower quadrantanopia
Visual field defect caused by a Left PCA infarct? Left hemianopia with macular sparing
The Meyer loop course: Lower retina; Loops around inferior horn of Lateral ventricle
Dorsal optic radiation: Superior retina; takes shortest path via internal capsule
Which brain area is traversed or caused by the Dorsal Optic radiation? Internal capsule
An infarct to the internal capsule will most likely cause defects to the superior or lower retina? Superior retina
Meyer Looop damage or lesion will cause problems with the lower or superior retina? Lower retina
What areas of the brain are involved or anatomically approximate to with the Meyer Loop? Inferior horn of lateral ventricle
When an image hits the Primary visual cortex, it is ===> Upside down and left-right reversed
Where is the light of an image if it is upside down, and Left-right reverse? Primary visual cortex
What is the Cavernous sinus? Collection of venous sinuses on either side of pituitary.
Where does the blood from eye and superficial cortex drains into? Cavernous sinuses
Collection of venous sinuses on either side of the pituitary. Cavernous sinuses
The contents oft he Cavernous sinuses drain into ----> Internal jugular vein
The internal jugular vein receives content (blood) from which structure? Cavernous sinuses
Which Cranial nerves and other nervous system structures pass through the Cavernous sinus? - CNs: III, IV, V1, and V2 - Postganglionic sympathetic pupillary fibers en route to orbit
What are signs and features of Cavernous sinus syndrome? 1. Ophthalmoplegia, 2. Decreased corneal sensation 3. Horner syndrome 4. Occasional decreased maxillary sensation
What are secondary causes for Cavernous sinus syndrome? Pituitary tumor mass effect, Carotid-cavernous fistula, or Cavernous sinus thrombosis related to infection
Which cranial nerve that goes through the cavernous sinus is most susceptible to injury in Cavernous sinus syndrome? CN VI
What is Internuclear Ophthalmoplegia? A disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction.
What is the Medial Longitudinal fasciculus? Pair of tracts that allows for crosstalk between CN VI and CN III nuclei.
What it the role of the MLF? Coordinates both eyes to move in same horizontal direction
Which structure is in charge to move eyes to same horizontal side, together? Medial longitudinal fasciculus (MLF)
Bilateral lesions to the MLF are common in: Multiple sclerosis
Why is the MLF highly myelinated? Must communicate quickly so eyes move at the same time
What is the most common conditions due to MLF damage? Internuclear Ophthalmoplegia (INO)
Conjugate horizontal gaze palsy. Internuclear Ophthalmoplegia (INO)
Lack of communication such that when CN 6 nucleus activités ipsilateral lateral rectus, contralateral CN 3 does not stimulate medial rectures to contract Internuclear Ophthalmoplegia (INO)
What action causes eye to get nystagmus in INO? Abducting the eye
What causes the nystagmus in INO by abducting the affected eye? CN VI overfires to stimulate CN III
In Right INO, which eye is paralyzed, right or left? Right
How is convergence in INO? Normal
What is Leukocoria? Loss (whitening) of the red reflex
What are some causes for Leukocoria in children? Retinoblastoma, congenital cataract, and toxocariasis
What are the 4 herniation syndromes? 1. Cingulate (subfalcine) herniation under falx cerebri 2. Central/downward transtentorial herniation 3. Uncal transtentorial herniation 4. Cerebellar tonsillar herniation into the foramen magnum
A Cingulate herniation syndrome can ---> Compress anterior cerebral artery
Which artery is at risk of compression by a Cingulate herniation under the falx cerebri? Anterior cerebral artery (ACA)
ACA may be compressed by which herniation syndrome? Cingulate herniation under the falx cerebri
What is a Central/downward transtentorial herniation? Caudal displacement of brain stem which causes rupture of Paramedian basilar artery branches causing Duret hemorrhages
Duret hemorrhages are due to rupture of which arteries? Paramedian basilar artery branches
What causes the rupture of Paramedian basilar artery branches in a Central transtentorial herniation? The caudal displacement of the brain stem
The presence of Duret hemorrhages are associated with which herniation syndrome? Central/downward transtentorial herniation
Uncus = Medial Temporal lobe
What word can be used to refer to the "Medial Temporal lobe"? Uncus
What does an early Uncal transtentorial herniation causes? Ipsilateral blown pupil and contralateral hemiparesis
What does a late Uncal Transtentorial herniation causes? Coma and Kernohan phenomenon
What is the "Kernohan phenomenon"? Misleading contralateral blown pupil and ipsilateral hemirarers due to contralateral compression against Kernohan notch
Which herniation syndrome is associated with Kernohan phenomenon? Late Uncal Transtentorial herniation
Misleading contralateral blown pupil and ipsilateral hemiparesis due to contralateral compression against Kernohan notch. Kernohan phenomenon
What are the consequences of a Cerebellar tonsillar herniation into the foramen magnum? Coma and death result when these herniations compress the brain stem
What is the most feared structure to be compressed by a Cerebellar tonsillar herniation into the foramen magnum? Brain stem
Why is does a Cerebellar tonsillar herniation into the foramen magnum so feared? If it compresses the brain stem it can cause comma and death
What are the MOTOR neurons signs? 1. Weakness 2. Atrophy 3. Fasciculations 4. Reflexes 5. Tone 6. Babinski 7. Spastic paresis 8. Flaccid paralysis 9. Clasp knife spasticity
Motor neuron lesions are divided into: Upper and Lower
Lower motor neuron injury means: Less muscle mass, decreased muscle tone, decreased reflexes, and downgoing toes
Upper motor neuron injury means: Everything up (tone, DTRs, toes)
What are fasciculations? Muscle twitching
When is a (+) Babinski sign normal? In an infant
UMN and LMN injuries, both show with a positive _______________. Weakness
Which Motor neuron signs are (+) in LMN injury? Weakness, Atrophy, Fasciculations, and Flaccid paralysis
A person with Fasciculations, most likely suffered a UMN or LMN lesion? LMN lesion
Flaccid paralysis is seen in UMN or LMN lesion? LMN lesion
Which motor neuron sings are DECREASED in a LMN lesion? Reflexes and Tone
Which are (+) motor neuron signs in a UMN lesion? Weakness, Babinski, Spastic paresis, and Clasp knife spasticity
Reflexes and tone, are increased in a __________ motor neuron lesion. UMN lesion
List of Spinal lesion diseases: 1. Spinal muscular atrophy 2. Amyotrophic lateral sclerosis 3. Complete occlusion of anterior spinal artery 4. Tabes dorsalis 5. Syringomyelia 6. Vitamin B12 deficiency 7. Cauda Equina syndrome
Congenital degeneration of anterior horns of spinal cord. Dx? Spinal muscular atrophy
What type of motor neuron deficits are seen in Spinal muscular atrophy? LMN symptoms
What mutation is associated with Spinal muscular atrophy? AR mutation in SMN1 leading to defective snRNP assembly
What is the clinical presentation of Spinal muscular atrophy? - LMN symptoms only, - Symmetric weakness - "Floppy baby" with marked hypotonia - Tongue fasciculations
What is another way to refer to Spinal Muscular Atrophy (SMA) type 1? Werdnig-Hoffmann disease
Werdnig-Hoffmann disease is the same as: Spinal muscular atrophy type 1
What part(s) of the Spinal cord is affected in Werdnig-Hoffmann disease? Anterior horns of spinal cord
What is the common name for Amyotrophic lateral sclerosis (ALS)? Lou Gehrig disease
What symttoms are seen in ALS? Combined UMN and LMN degeneration.
In ALS (Lou Gehrig disease) what produces the UMN deficits? Degeneration of the corticobulbar and corticospinal tracts
What tract degeneration produces the LMN deficits seen in ALS? Degeneration of medullary and spinal cord
UMN + LMN lesion deficits with no sensory or bowel/bladder deficits. Dx? Amyotrophic lateral sclerosis
What is a common cause of Lou Gehrig disease? Defect in Superoxide dismutase 1
Defective Superoxide dismutase 1. Dx? Amyotrophic lateral sclerosis
What are the common LMN deficits seen in ALS? Flaccid limb weakness, fasciculations, atrophy, bulbar palsy
What is seen in Bulbar palsy? Dysarthria, dysphagia, and tongue atrophy
Which Spinal cord disorder is associated with Bulbar palsy? Amyotrophic lateral sclerosis
What are the UMN deficits seen with ALS? Spastic limb weakness, hyperreflexia, clonus, pseudobulbar palsy
What symptoms are associated with Pseudobulbar palsy? Dysarthria, dysphagia, and emotional lability
What is the common treatment for ALS? Rilouzole
What condition is treated with Rilouzole? Amyotrophic lateral sclerosis
Which tracts (parts of spinal cord) are spared in "Complete occlusion of ASA"? Dorsal columns and Lissauer tract
Which artery supplies the ASA below T8? Artery of Adamkiewicz
What is a common cause for Complete Occlusion of Anterior Spinal artery? Aortic aneurysm repair
What are the common clinical signs or symptoms of Complete Occlusion of ASA? 1. UMN deficit below the lesion (corticospinal tract), 2. LMN deficit at the level of the lesion (anterior horn), 3. Loss of pain and temperature sensation below the lesion (spinothalamic tract).
What parts of the Spinal cord are affected by the complete occlusion of the ASA? Corticospinal tract, anterior horn, and Spinothalamic tract.
What UMN deficits are seen in Complete Occlusion of the ASA? Deficit below the level of lesion
LMN or UMN deficits are seen at the level of lesion by Complete occlusion of ASA? LMN deficits
What is the result of damage to the Spinothalamic tract in Complete occlusion of the ASA? Loss of pain and temperature sensation below the lesion
What causes Tabes dorsalis? Tertiary syphilis
What are the pathological changes or results caused by Tabes dorsalis? Degeneration/ demyelination of dorsal columns and roots leading to progressive sensory ataxia
What are the clinical features caused by Progressive sensory ataxia caused by Tabes dorsalis? Impaired proprioception with causes poor coordination
(+) Romberg sign and absent DTRs. Dx? Tabes dorsalis
What are featured signs of Tabes dorsalis? - Charcot joints, - Shooting pain - Argyll Robertson pupils
(+) Argyll Robertson pupils. Dx? Tabes dorsalis
What spinal cord condition is associated with tertiary syphilis? Tabes dorsalis
Syrinx expand and damages anterior white commissure of spinothalamic tract. Syringomyelia pathogenesis
What is the result of Syringomyelia pathogenesis? Bilateral symmetric los of pain and tempreatio nsesaton in cape-like distribution
Chiari I malformation are associated with which Spinal cord condition? Syringomyelia
What is the featured sensation loss of Syringomyelia? Cape-like distribution loss of pain and temperature
What condition is known to affect the anterior white commissure of the Spinothalamic tract? Syringomyelia
What another name given to Vitamin B12 deficiency? Subacute combined degeneration
What tracts are demyelinated in Subacute combined degeneration? - Spinocerebellar tracts - Lateral Corticospinal tracts - Dorsal columns
What are the neurological symptoms seen in Vitamin B12 deficiency? Ataxic gait, paresthesia, impaired position/vibration sense, and UMN symptoms.
Cauda equina syndrome is due to: Compression of spinal roots L2 and below, often due to intervertebral disc herniation or tumor.
The herniation if the intervertebral disc, causing compression of spinal roots L2 and below. Dx? Cauda equina syndrome
What the clinical signs of Cauda equina syndrome? Radicular pain, absent knee and ankle reflexes, loss of bladder and anal sphincter control, and saddle anesthesia
Absence of the knee and ankle reflexes could represent what spinal cord condition? Cauda equina syndrome
What is saddle anesthesia? A loss of sensation restricted to the area of the buttocks, perineum and inner surfaces of the thighs.
What type of pain is associated with Cauda equina syndrome? Radicular pain
What pathogen causes Poliomyelitis? Poliovirus
Poliomyelitis is due to: Infections causes destruction of cells in anterior horn of spinal cord (LMN death)
Where does the Poliovirus replicate to cause Poliomyelitis? Oropharynx and small intestine before spreading via bloodstream to CNS.
What are the common LMN deficits seen in Poliomyelitis? Asymmetric weakness, hypotonia, flaccid paralysis, fasciculation, hyporeflexia, and muscle atrophy.
How does the LMN deficits different in Poliomyelitis and Spinal muscular atrophy? Poliomyelitis develops ASYMMETRIC weakness, while, Spinal muscular atrophy develos symmetric weakness.
If the patient demonstrates asymmetric weakness, is it Spinal muscular atrophy or poliomyelitis? Poliomyelitis
What condition is due to hemisection of spinal cord? Brown-Sequard syndrome
What is the cause of Brown-Sequard syndrome? Hemisection of spinal cord
What are the main 5 findings of Brown-Sequard syndrome? 1. Ipsilateral loss of all sensation at level of lesion 2. Ipsilateral LMN signs at level of lesion 3. Ipsilateral UMN signs below level of lesion 4. Ipsilateral loss of proprioception, vibration, light touch, and tactile sense below level of lesion 5. Contralateral loss of pain, temperature, and crue touch below level of lesion
What is a risk or a consequence, of Brown-Sequard syndrome above (lesion) T1? Ipsilateral Horner syndrome due to damage to oculosympathetic pathway
LMN deficits in Brown-Sequard syndrome? Ipsilateral LMN signs at level of lesion
What are the contralateral deficits seen in Brown-Sequard syndrome? Loss of pain, temperature, and crude touch below level of lesion
What are the ipsilateral symptoms below the level of lesion of Brown-Sequard syndrome? 1. UMN signs 2. Impaired proprioception, vibration, light touch, and tactile sense
What are the deficits seen ipsilaterally at the level of the lesion of Brown-Sequard syndrome? 1. Loss of sensation 2. LMN signs
Contralateral or Ipsilateral signs: Impaired pain, temperature, crude touch sensation in Brown-Sequard syndrome. Contralateral
Autosomal recessive trinucleotide repeat disorder (GAA)n on chromosome 9 in gene that encodes frataxin. Dx? Friedreich ataxia
What chromosome is involved in the mutation of Friedreich ataxia? Chromosome 9
What is "frataxin"? Iron binding protein
Which tracts are degenerated in Friedreich ataxia? 1. Lateral Corticospinal tract 2. Spinocerebellar tract 3. Dorsal columns 4. Dorsal root ganglia
What is the clinical result of degeneration of the lateral corticospinal tract in Friedreich ataxia? Spastic paralysis
What produces the loss of DRTs in Friedreich ataxia? Degeneration of dorsal root ganglia
What are symptoms of Friedreich ataxia? Staggering gaint, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy
Which condition is often associated with childhood with Kyphoscoliosis? Friedreich ataxia
What featured bone abnormalities in Friedreich ataxia? Pes cavus and Hammer toes
Cardiac abnormality associated with Friedreich ataxia? Hypertrophic cardiomyopathy.
Hypertrophic, Restrictive, or Dilated cardiomyopathy, which is associated with Friedreich ataxia? Hypertrophic cardiomyopathy
A person with trinucleotide condition associated with Staggering gain and frequent falls? Friedreich ataxia
What is the most common cause of death in Friedreich ataxia? Hypertrophic cardiomyopathy
What is the trinucleotide associated with Friedreich ataxia? GAAn
What are the consequences of CN V motor lesion? Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle
In a CN V motor lesion , does the jaw deviate away or toward the side of lesion? Toward
Why does a CN V motor lesion has a ipsilateral jaw deviation? Due to unopposed force from the opposite pterygoid muscle
Which muscle has not enough forced by itself to counteract the deviation toward injured side of CN V motor nerve? Pterygoid muscle
What is the consequence or clinical presentation of CN X lesion? Uvula deviates away from side of lesion
Is the uvula deviation toward or away from side of lesion in a CN X injury? Away
What causes the contralateral deviation of the uvula in a CN X lesion? Weak side collapse and uvula points away
Upon physical examination the uvula is deviated away from presented injured side. What is the suspected CN damaged? CN X
What is the clinical presentation of CN XI lesion? Weakness turning head to contralateral side of lesion
Weakness turning head to contralateral side of lesion is due to what kind of cranial nerve damage? CN XI lesion
What are the clinical results of CN XI lesion? 1. Weakness turning head to contralateral side of lesion 2. Shoulder drop on side of lesion
What ipsilateral muscle is damaged in CN XI lesion that cause the shoulder drop? Trapezius
Which muscle is affected by CN XI lesion? Contralateral Sternocleidomastoid
What is the ipsilateral sign of a CN XI lesion? Shoulder drop
The left SCM contract to help ====> Turn the head to the right
What is the consequences of a CN XII lesion? Tongue deviates toward side of lesion
Why is the tongue deviates toward of CN XII lesion? Due to weakened tongue muscles on affected side
A CN XII lesion is considered a _______________ lesion. LMN lesion
Does tongue deviate toward or away from affected side in a CN XII lesion? Toward
The expression "lick your wounds" is used to describe aht type of CN lesion? CN XII lesion
If the tongue is deviated, which cranial nerve is most likely affected? CN XII
If the Jaw is deviated, which cranial nerve is most likely affected? CN V motor
What body part is affected and by consequence deviated in a CN X? Uvula
What two parts of the body are affected in a CN XI lesion? Sternocleidomastoid muscle (neck) and Trapezius muscles (shoulder)
What is the most common cause of peripheral facial palsy? Bell palsy
What is the most common pathogen associated with the development of Bell palsy? Reactivation of HSV
What is the treatment for Bell palsy due to HSV reactivation? Corticosteroids + acyclovir
List of causes of peripheral facial palsy? 1. Reactivation of HSV infection 2. Lyme disease 3. Herpes zoster (Ramsay Hunt syndrome) 4. Sarcoidosis 5. Tumors 6. Diabetes mellitus
What is Ramsay Hunt syndrome? A complication of shingles. It is the name given to describe the symptoms of a shingles infection affecting the facial nerve
What is the location of the lesion of Facial nerve palsy that produces UMN deficits? Motor cortex, connection from motor cortex to facial nucleus in pons
If the Facial nerve palsy prices UMN deficits, will these be contralateral or ipsilateral? Contralateral
What are the muscles involved or affected in Facial nerve palsy with UMN deficits? Lower muscles of facial expression
If the forehead is spared (not involved), the facial nerve palsy is of UMN or LMN affectio? UMN
Why is the forehead spared in facial nerve palsy with UMN lesion? Due to bilateral UMN innervation
Is UMN or LMN innervation bilateral, that a facial nerve palsy does not affect the foreadhad? UMN
Lesion location of facial nerve palsy with a LMN injury? Facial nucleus, anywhere along CN VII
Which nerve is affected in LMN Facial nerve palsy? CN VII
Ipsilateral or contralateral, the effects of LMN facial nerve palsy? Ipsilateral
Which type of lesion deficits in facial nerve palsy, affect the Upper and lower muscles of facial expression? LMN Facial nerve palsy
If both, upper and lower muscles of facial expression are affected by Facial nerve palsy, it is safe to assume the forehead will be or will not be affected? Affected forehead
LMN lesion or UMN lesion if facial nerve palsy involves only lower muscles of facial expression? UMN lesion
What are associated symptoms of LMN Facial nerve palsy? - Incomplete eye closure, - Hyperacusis - Loss of taste and sensation to anterior tongue
CN VII LMN lesion ---> Peripheral; cannot wrinkle forehead
If patient present with a facial nerve palsy, and is UNABLE to wrinkle the forehead, it indicates a ______________ lesion. LMN
What are the main division of the ear? Outer ear, Middle ear, and Inner ear
What accounts for the Outer ear? Visible portion of ear (pinna), includes auditory canal and tympanic membrane.
How does the Outer ear transmit sound? Via vibration of tympanic membrane
What is the "pinna"? Visible portion of ear
What is included, besides the pinna, in the Outer ear? Auditory canal and tympanic membrane
What is the Middle ear? Air-filled space with three bones called the ossicles
What is the name given to group of three bones found in the Middle ear? Ossicles
In which division of ear are the "ossicles" located? Middle ear
The auditory canal is in the ______________ ear. Outer ear
Which division or part of the ear has the tympanic membrane? Outer ear
What are the names of the 3 ossicles? Malleus, incus, and Stapes
What is the Malleus? One of three ossicles (bones) in the middle ear.
The Malleus, ______________ and ______________, are the ossicles. Incus and Stapes
What is the role or function of the ossicles? Conduct and amplify sound from tympanic membrane to inner ear
What ear structure(s) is responsible to conduct and amplify sound from the tympanic membrane to the inner ear? Ossicles
Snail-shaped, fluid-filled cochlea. Inner ear
What part of the ear contains the basilar membrane? Inner ear
Vibrates secondary to sound waves Basilar membrane
How is vibration transduced in the inner ear? Via specialized hair cells --> auditory nerve signaling --> brain stem.
Where in the inner ear does low frequency sounds are heard? Apex near helicotrema
What type of frequency is perceived at the cochlea? High frequency
Sound heard best at base of cochlea. High frequency
What are the two types of hearing loss (diagnostically)? 1. Conductive hearing loss 2. Sensorineural hearing loss
What are the two common tests performed to diagnose hearing loss? Weber test and Rinne test
What type of hearing loss produces an abnormal Rinne test? Conductive hearing loss
Which hearing test when performed it test the localization of sound? Weber test
Which type of hearing loss is seen with Weber test that localized sound to affected ear? Conductive hearing los
Sensorineural hearing loss Weber test: Localizes to affected ear
A Weber test in the Conductive hearing loss: Localizes to affected ear
Weber test n Sensorineural hearing loss: Localizes to affected ear
Which auditory test is directed to indicate the localization of sound? Weber test
Which auditory test is intended to indicate bone and air conductivity? Rinne test
A person with Conductive hearing loss will have _______________ Rinne test. Abnormal
What indicates a Normal Rinne test? Air conductive > Bone conductivity
If the sound/vibratory conductivity of bone is larger, then Rinne test is _____________________. Abnormal
Which type of hearing loss experiences a normal Rinne test? Sensorineural hearing loss
Which type of hearing loss experiences an abnormal Rinne test? Conductive hearing loss
Weber test -> Localized to affected ear Rinne test --> Abnormal What is the hearing loss type? Conductive hearing loss
Weber test --> Localizes to unaffected ear Rinne test --> Normal What is the hearing loss type? Sensorineural hearing loss
Which type of hearing loss has the sound localized to the "good" ear in a Weber test? Sensorineural hearing loss
Which type of hearing loss will have the sound/vibration to localized at the "bad" or affected ear? Conductive hearing loss
Bone > air Abnormal Rinne test seen in Conductive hearing loss
What are the two most common types of hearing loss? 1. Noise-induced hearing loss 2. Presbycusis
What is "Noise-induced hearing loss"? Damage to stereociliated cell in organ of Corti
In Noise-induced hearing loss, which hearing frequency is lost first? High-frequency hearing
What is a severe consequence of a sudden, extremely loud noise? Hearing loss due to tympanic membrane rupture
The rupture of the tympanic membrane due to a sudden and extremely loud noise, is an example of which type of hearing loss? Noise-induced hearing loss
What is Presbycusis? Aging-related progressive bilateral/symmetrical sensorineural hearing loss du tot destruction of hari cell at the cochlear base.
Destruction of hair cell at the cochlear base, leads to what type of hearing loss? Presbycusis
What population is most common to develop Presbycusis? Elderly
Hearing loss associated with increasing age. Presbycusis
What hearing is preserved in Presbycusis? Low-frequency hearing at apex
What is destroyed in Presbycusis that leads to hearing loss? Hair cells at the cochlear base
Overgrowth of desquamated keratin debris within the middle ear space. Cholesteatoma
What is a Cholesteatoma? Overgrowth of desquamated keratin debris within the middle ear space
Which part of the ear develops Cholesteatomas? Middle ear
What type of hearing loss, conductive or sensorineural, is seen with Cholesteatoma? Conductive hearing loss
What causes the conductive hearing loss in a Cholesteatoma? The erosion ossicles, mastoid air cells
Painless otorrhea is a common symptom of _____________________. Cholesteatoma
Middle ear mass + Painless otorrhea. Dx? Cholesteatoma
Vertigo: Sensation of spinning while actually stationary
What is a subtype of "dizziness," but distinct form "lightheadedness"? Vertigo
What are the two types of vertigo? - Central vertigo - Peripheral vertigo
What is more common , peripheral or central vertigo? Peripheral vertigo
__________________ vertigo is an inner ear etiology. Peripheral vertigo
What parto fo the ear etiology is peripheral vertigo considered? Inner ear
What is the difference in etiology between Peripheral and Central vertigo? Peripheral vertigo is an inner ear condition, while Central Vertigo is due to Brain stem or cerebellar lesion
What are common etiologies or condition that lead to development of Peripheral vertigo? 1. Semicircular canal debris 2. Vericular nerve infection 3. Meniere disease 4. Benign Paroxysmal Positional Vertigo (BPPV)
What is the treatment for Peripheral vertigo? Antihistamines, anticholinergics, antiemetics
Besides the general medications for Peripheral vertigo, what else is used to treat Peripheral vertigo caused by Meniere disease? Low-salt diet + diuretics (if needed)
For which condition is the Epley maneuver performed? Treatment of BPPV
BPPV causes _______________ vertigo. Peripheral vertigo
What is the common triad associated with Meniere's disease? 1. Sensorineural hearing loss 2. Vertigo 3. Tinnitus
A person with normal Rinne test, Weber test localized sound to non-affected ear, describes currently the room spinning around and a constant ring in the affected ear. Dx? Meniere disease
What would be the Weber test for a Meniere's disease patient? Localizes to unaffected ear
What does the Rinne test on a person with Meniere's disease demonstrate? Normal; Air conduction is greater than bone conduction of sound and vibration.
What are two examples of etiologies that may cause brainstem or cerebellar lesions, leading to develop Central vertigo? Stroke affecting vestibular nuclei or posterior fossa tumor
What ar the findings in Central vertigo? - Directional or purely vertical nystagmus - Skew deviation - Diplopia - Dysmetria - Focal neurologic findings
Which type of vertigo is associated with vertical nystagmus and skew deviation? Central vertigo
A ________________- fossa tumor may cause Central vertigo. Posterior
What is Benign Paroxysmal Positional vertigo (BPPV)? Sudden sensation that you're spinning or that the inside of your head is spinning
What is the Epley manuveur? Type of exercise help that helps to treat the symptoms of benign paroxysmal positional vertigo (BPPV)
List of Vagal nuclei: 1. Nucleus Solitarius 2. Nucleus Ambiguus 3. Dorsal motor nucleus
What is the function of the Nucleus solitarius? Visceral sensory information (taste, baroreceptors, gut distension)
Which cranial nerves associated with the Vagal Nucleus solitarius? VII, IX, and X
Motor innervation of pharynx, larynx, and upper esophagus. Which vagal nuclei is described? Nucleus ambiguus
What actions are performed or regulated by Nucleus ambiguus? Swallowing and palate elevation
CNs involved in the nucleus ambiguus IX, X, and XI
Which is the only cranial nerve involved with the Dorsal motor nucleus? X
What is the function of the Dorsal motor nucleus? Sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI.
What are some common cranial nerve reflexes? Corneal, Lacrimation, Jaw jerk, Pupillary, and gag reflexes.
Afferent corneal reflex is done by which nerve? V1 Ophthalmic (nasociliar y branch)
Which CN gives rise to the efferent Corneal reflex? Bilateral VII (temporal branch: orbicularis oculi)
Which reflex is checked by testing Bilateral VII (temporal branch)? Efferent Corneal reflex
Which cranial nerve reflexes are regulated by the CN V1? Afferent Corneal and Afferent Lacrimation reflexes
Does the loss of the afferent lacrimation reflex does not ---> Preclude emotional tears
Which CN must be tested in order to check for Efferent lacrimation reflex? VII
CN V3 cranial afferent reflex? Jaw jerk
Cranial nerve reflex: Sensory-muscle spindle form masserter Afferent Jaw jerk reflex due to V3 stimulation
Efferent Jaw jerk cranial reflex: V3 (motor -masseter)
Which muscle is involved in both efferent and afferent Jaw jerk cranial nerve reflex? Masseter
Which CN is involved in the efferent part of the Pupillary cranial reflex? CN III
What is the cranial nerve involved in the afferent part of the Pupillary reflex? CN II
Which reflex is checked by testing CN II? Afferent Pupillary reflex
A damaged CN III, will cause loss of what part of the pupillary reflex? Efferent Pupillary reflex
CN _____ is involved in afferent gag reflex. IX
Which CN is involved in the efferent part of the gag reflex? X
Damaged CN X will cause a deficit in which cranial nerve reflex? Efferent Gag reflex
How many (number) muscles close the jaw? 3
How many (number) muscles are needed to open the jaw? 1
Which muscles are used to close the jaw? Masseter, Temporalis, and Medial pterygoid
Which muscle is used to open the jaw? Lateral pterygoid
All mastication muscles ar innervated by which cranial nerve? CN V3
Which subdivision of the Trigeminal nerve is in charge to innervate all opening and closing jaw muscles? V3
Which Pterygoid muscle is used to open the jaw, lateral or medial? Lateral
The Medial pterygoid muscle _______________ the jaw. Closes
Masseter, Temporalis, and Medial pterygoid. Mastication muscles that close the jaw
Total number of pairs of spinal nerves 31
How are all 31 pairs of spinal nerves categorized? - 8 cervical pairs - 12 thoracic pairs - 5 lumbar pairs -5 sacral pais - 1 coccygeal pair
How many Cervical Spinal nerve pairs exist? 8
Which subdivision has the most spinal nerve pairs? Thoracic with 12 pairs
Which spinal nerves have each 5 pairs? Lumbar and Sacral
How many coccygeal spinal nerve pairs exist? 1
Which spinal nerves exit above the corresponding vertebra? Nerves C1-C7
What is anatomically important about Spinal nerves C1-C7? Exit ABOVE the corresponding vertebra
Do spinal nerves form C1-C7 exit above or below, the corresponding vertebrae? Above
Which is the only spinal nerve that exits above and below the corresponding vertebra? C8 spinal nerve
C8 spinal nerve exits ---> Below C7 and above T1
C8 spinal nerve exits above the _________. T1
C8 spinal nerve exits below the ________. C7
Nerves below the C8 exit ____________ corresponding vertebra. Below
Where would C3 spinal nerve exit the vertebrae? Above the 3rd cervical vertebra
Where would L2 spinal nerve exits the vertebra? Below the 2nd lumbar vertebra
What is a Vertebral Disc herniation? Nucleus pulposus herniates through annulus fibrosus
MC location anatomically for Vertebral disc herniation Posterolaterally at L4-L5 or L5-S1
In a vertebral disc herniation, which nerve is usually affected? Nerve below the level of herniation
Absent ankle reflex is due to compression of which spinal nerve root? S1
Compression of S1 nerve root ----> Absent ankle reflex
In a vertebral disc herniation of L3-L4, which nerve is affected and which would be spared? L3 would be spared, while L4 is affected
What is the soft central disc of vertebrae also known as? Nucleus pulposus
Another way to refer to the outer ring by which a vertebral disc herniation goes through? Annulus fibrosus
How far does an adult lower spinal cord normally extend to? L1-L2 vertebrae
The subarachnoid space extends how far in healthy adults? Lower border of S2 vertebra
Most common and best locations for a Lumbar puncture? L3-L4 or L4-L5
Why is an LP (lumbar puncture) usually performed in L3-L5 area? Level of Cauda Equina
What is the most likely location of the cauda equina in a healthy adult? L3-L5 vertebrae
What is the ultimate goal of a Lumbar puncture (LP)? Obtain sample of CSF without damaging spinal cord
What are the two DESCENDING spinal cord tracts? 1. Lateral Corticospinal tract 2. Anterior Corticospinal tract
What are the divisions of the Lateral corticospinal tracts? Sacral and Cervical tracts
What is controlled or regulated by the Descending tracts of the Spinal cord? Voluntary motor
List of all ASCENDING spinal tracts: 1. Dorsal column (Fasciculus gracilis, and Fasciculus Cuneatus) 2. Lateral spinothalamic tract 3. Anterior spinothalamic tract
What type of sensory information is controlled or sensed by the Dorsal column? Pressure, vibration, fine touch, and proprioception.
What are the divisions of the Dorsal column?? 1. Fasciculus gracilis 2. Fasciculus cuneatus
Fasciculus gracilis controls which part of the body? Lower body, legs
Fasciculus cuneatus provides sensory information to which part of the body? Upper body, arms
An injury to the F. cuneatus will cause deficits in sensation in the ______________. Upper body and arms
What spinal tract sense pressure, vibration, fine touch, and proprioception? Dorsal column
What is sense the Lateral Spinothalamic tract? Pain and temperature
What is sense by the Anterior Spinothalamic tract? Crude touch, and pressure
Which parts of the dorsal column are the most medial in respect of the spinal cord? Sacral an lumbar
Damage to the Lateral spinothalamic tract will cause Deficit in sensing pain and temperature
Ascending or Descending. Lateral Spinothalamic tract: Ascending
Ascending or Descending: Anterior Spinothalamic tract: Ascending
The Dorsal Column is ascending or Descending tract? Ascending
Ascending and Descending. Fasciculus gracilis? Ascending
Fasciculus Cuneatus is it descending or ascending? Ascending
Ascending or Descending. Lateral corticospinal tract? Descending
Ascending or Descending. Anterior Corticospinal tract? Descending
Name of the anterior descending spinal cord tract: Anterior Corticospinal tract
Key. If the name of the of the spinal tract has the cord "Cortico-" is ascending or descending? Descending
The spinothalamic tracts are both ____________________________. Ascending
Pain and temperature are sensed by which spinal cord tract? Lateral Spinothalamic tract
Crude touch and pressure are sensed or relayed by which cord tract? Anterior Spinothalamic tract
Complete sentence. "Ascending tracts ________________........" Synapse and then cross
Which tracts synapse and then cross? Ascending tracts
1st-Orden Neuron of Dorsal column: Sensory nerve ending --> bypass pseudounipolar cell body in dorsal root ganglion --> enter spinal cord --> ascend ipsilaterally in dorsal column
Where is the Synapse 1 of Dorsal column? Nucleus gracilis, nucleus cuneatus (ipsilateral medulla)
Decussates in medulla and then ascends contralaterally as the medial lemniscus. 2nd-order neuron in Dorsal column tract
Where is the Synapse 2 of the Dorsal column? VPL of the Thalamus (sensory cortex)
What are the two division of the Spinothalamic tract? Lateral and Anterior
Describe the mechanism of the 1st order neuron in the Spinothalamic tract: Sensory nerve ending --> bypass pseudounipolar cell body in dorsal root ganglion and finally entering the spinal cord
Where is the Synapse 1 of the Spinothalamic tract? Ipsilateral gray matter (in spinal cord)
2nd-order Neuron of the Spinothalamic tract: Decussates in spinal cord as the anterior white commissure and then ascends contralaterally
The dorsal column 2nd-order neuron decussates in the ___________________ to tehn ascend contralaterally. Medulla
Which important structure provides the ascend of the second order neuron of the Dorsal column? Medial lemniscus
What can be found to travel up alongside the second order neuron of the dorsal columns? Medial lemniscus
Where is the Synapse 2 of the spinothalamic tract? VPL of the Thalamus (sensory cortex)
If the Synapse 2 is the VPL of the thalamus, which are the two possible tracts? Dorsal columns and Spinothalamic tracts
Crossing the spinal cord at the white commissure is seen in which ascending tract? Spinothalamic tract
Which tract has function for Voluntary movement of contralateral limbs? Lateral corticospinal tract
What is the 1st-order neuron function of the Lateral corticospinal tract? UMN: cell body in primary motor cortex --> descends ipsilateral, and most fibers decussate at the caudal medulla
At what point the first-order neuron of the lateral corticospinal tract decussatus? Caudal medulla
The decussation of the first-order neuron of the lateral corticospinal tract is known as: Pyramidal decussation
Which gtract is known to "descend contralaterally"? Lateral corticospinal tract
Which is the 1st-order neuron of the lateral corticospinal tract, UMN or LMN? UMN
Where does the Synapse 1 of the Lateral corticospinal tract occurs? Cell body of anterior horn of the spinal cord
What is the most likely referred tract, if the synapse 1 happens that the cell body of anterior horn of spinal cord? Lateral corticospinal tract
LMN of the Lateral corticospinal tract is the ----> Second-order neuron pathway
Where is the synapse 2 of the lateral corticospinal tract? Neuromuscular junction (NMJ) ---> muscle fibers
What are the 4 main clinical reflexes? 1. Achilles reflex 2. Patellar reflex 3. Biceps and brachioradialis reflexes 4. Triceps reflex
Nerve roots of the Achilles reflex S1 and S2
Which is the main nerve root of the Achilles reflex? S1
A damage to the S1, S2 nerve roots will cause --> Weak or absent Achilles reflex
Damage to nerve roots L3 , L4 causes: Weak or absent Patellar reflex
What are the nerve roots of the Patellar reflex? L3 and L4
Which is the main nerve root for the Patellar reflex? L4
Which reflex is tested by checking L3/L4 nerve roots? Patellar reflex
The Biceps and Brachioradialis reflexes are tested by checking which nerve roots? C5 and C6
Which is the main nerve root for the Biceps and Brachioradialis reflexes? C5
Which important clinical reflex is tested by the C5 and C6 nerve roots? Biceps and Brachioradialis reflexes
S1, S2 nerve roots ------> reflex? Achilles
L3, L4 nerve roots -----> reflex? Patellar
C5, C6 nerve roots ------> reflex? Biceps and Brachioradialis
Which are the nerve roots involved in the Triceps reflex? C7 and C8
Which is the main nerve root in the Triceps reflex? C7
C7, C8 nerve roots -----> reflex? Triceps
To check the Triceps reflex, the clinician must stimulate which nerve roots? C7 and C8
A injury to the C7 or C8 nerve roots will cause: Weak or absent Triceps reflex
Damage to the C5 or C6 nerve roots will cause: Weak or absent Biceps and Brachioradialis reflexes
"testicles move" reflex. Cremasteric reflex
Which clinical reflex is directed to the testicles? Cremasteric reflex
Which are the nerve roots involved in the Cremasteric reflex? L1 and L2
Damage to L1 or L2 nerve roots will probable cause abnormal __________ reflex. Cremasteric reflex
The phrase "winks galore" is used to describe or indicate which clinical reflex? Anal wink reflex
Which are the nerve roots involved in the Anal wink reflex? S3 and S4
Damage to the S3 or S4 nerve roots result in ----> Weak or absent anal wink reflex
CNS reflexes that are present in a healthy infant, but are absent in a neurologically intact adult Primitive reflexes
What are Primitive reflexes? CNS reflexes that are present in a healthy infant, but are absent in a neurologically intact adult
By when are Primitive reflexes normally gone? 1st year of life
What part of the brain is inhibit the primitive reflexes? Frontal lobe
What is a possible consequence of a frontal lobe lesion? Loss of inhibition (reemergence) of primitive reflexes
Description of the Moro reflex: "Hang on for life" reflex - abduct/extend arms when startled, and the draw together
The abduction/extension of arms when a baby is startled, and then draw back them together. Moro reflex
What is the rooting (primitive) reflex? Movement of head toward one side if cheek or moth is stroked
What is a common way to refer to the rooting reflex? Nipple seeking
The movement of an infant's head toward the side side of cheek or mouth that is stroked. Rooting reflex
What is the description of the Sucking reflex? Sucking response wehn roof of mouth is touch
Placing a finger in an infant roof of mouth should elicit what refeed in a healthy baby? Sucking reflex
What is the Palmar (primitive) reflex? Curling of fingers if palm is stroked
Curling of fingers as the palm of an infant is stroked. Palmar reflex
Definition of the Plantar reflex Dorsiflexion of large toe and fanning of other toes with plantar stimulation
What is the Babinski sign? Presence of Plantar reflex in an adult
A (+) Babinski sign indicates: UMN lesion
What reflex is seen with UMN lesion? (+) Babinski sign
What is the Galant reflex? Stroking alongside of the spine while newborn is in ventral suspension causes lateral flexion of lower body toward stimulated side
A physician places baby laying on its stomach and then gently strokes along side the right side of the spine. What is the reflex been tested? Galant reflex
What is the possible age of a healthy human with (+) plantar, Moro, and Rooting reflexes? Less than one year
What is the expected result or reaction of the Gallant reflex? Lateral flexion of lower body toward the stimulated side
If the galant reflex test is done on the left side, toward which side is the lower body flexion expected to occur? Left side
Dermatome C2 distribution Posterior half of skull
What dermatome is distributed or covers the posterior half of the skull? C2
Which dermatome distribution is described as "high turtle neck"? C3
What dermatomes are the ones that refer diaphragm and gallbladder pain to the right shoulder? C3, C4, and C5
Referred pain to the right shoulder is done via which nerve? Phrenic nerve
Low-collar shift dermatome distribution C4
What is the distribution of the C4 dermatome? Low-collar shirt
Which digits are included in C6 dermatome distribution? Thumbs
What is a Dermatome? An area of the skin supplied by nerves from a single spinal root.
An area of the skin supplied by nerves from a single spinal root Dermatome
By which dermatome are thumbs covered or prove skin nerve sensation? C6
Which dermatome location is described by "At the nipple"? T4
Which dermatome covers the nipple? T4
T4 dermatome distribution is at the ______________. Nipple
Which dermatome covers the Xiphoid process? T7
What part of body is covered by T7 dermatome? Xiphoid process
Which dermatome is located or distributed at the umbilicus? T10
Damage to spinal root T10 will cause lack of skin sensation tow which part of body (dermatome)? Umbilicus
T10 is a point referred with pain in which condition? Appendicitis
A patient will have pain at which dermatome ? T10
L1 dermatome distribution: At the Inguinal Ligament
What dermatome covers the Inguinal ligament? L1
L4 includes what part of the lower extremities? Kneecaps
Kneecap dermatome coverage is done by which spinal nerve root? L4
Dermatomes S2, S3, and S4 provide skin sensation to: Penile and anal zones
What areas of body would experience decreased or absent skin sensation case of S2-S4 dermatome damage? Penile and anal zones
Sensation of penile and anal zones is done by which dermatomes? S2, S3, and S4
What actions and/or functions are controlled by the Temporal lobe? 1. Language comprehension 2. Behavior 3. Memory 4. Hearing 5. Emotions
Which lobe has the area of the brain in charge of language comprehension? Temporal lobe
A person with changes in behavior, hearing, and memorey, as well with deficits in language comprehension, most likely suffered from an injury to which brain lobe? Temporal lobe
What functions and roles are controlled by the Pituitary gland? - Hormones - Growth - Fertility
Damage to the pituitary gland may represent damage into which overall characteristics: Hormonal activity, growth, and fertility
What physiological features are controlled by the Brain stem? 1. Breathing 2. Blood pressure 3. Heartbeat 4. Swallowing
Breathing, swallowing, BP, and HR are controlled all by which area of the CNS? Brain stem
What is coordinated by the actions of the Cerebellum? Balance, coordination, and Fine muscle control
A deficit in balance and coordination may represent damage to the ______________________. Cerebellum
Occipital lobe has which physiological feature under its control? Vision
Which brain lobe houses the vision control and ability? Occipital lobe
What are the roles/functions coordinated or controlled by the Parietal lobe? 1. Telling right from left 2. Calculations 3. Sensations 4. Reading 5. Writing
A person unable to distinguish "right" from "left" may present with damage to: Parietal lobe
A person that prior to a severe car accident was a math teacher, but after that was unable to read, write, or do mathematical calculations, may have injured which part of the brain? Parietal lobe
Reading is controlled by which lobe? Parietal lobe
Writing is controlled by which brain lobe? Parietal lobe
Acalculia is due to damage or injury to the _____________ lobe. Parietal lobe
List of actions controlled or managed by the Frontal lobe of the brain: 1. Movement 2. Reasoning 3. Behavior 4. Memory 5. Personality 6. Planning 7. Decision making 8. Judgement 9. Initiative 10. Inhibition 11. Mood
Which actions are controlled or coordinated by the Frontal and Temporal lobes of the brain? Behavior and memory
A person with movement deficits may have suffered an brain injury involving which lobe? Frontal lobe
Personality changes, may be due to injuries to the _____________ lobe. Frontal lobe
Unable to make decisions, as well as bad judgement calls, may represent an injury to which brain lobe? Frontal lobe
Which brain area or lobe has more actions or roles under its control? Frontal lobe
What is the sensory information conveyed by the Parietal lobe? Taste, smell, touch, sight, hearing, temperature, and pain
Which lobe of the brain is in charge of coordinating Spatial relationships? Parietal lobe
What are the Spatial relationships? - Hand-eye coordination - Recognizing body position - Judging distances - Moving between objects
Understanding what you see Sight
Sight is controlled by which brain lobe? Occipital lobe
Executive functions are controlled by which lobe? Frontal lobe
What are (list) of Executive functions? Planning, organizing, problem solving, decision-making, reasoning
Broca's area in frontal lobe is in charge of: Speaking fluently and with meaning
Wernicke's area in the Temporal lobe is in charge of: Understanding language and speech
List of Adult primary brain tumors: 1. Glioblastoma multiforme 2. Oligodendroglioma 3. Meningioma 4. Hemangioblastoma 5. Pituitary adenoma 6. Schwannoma
What is a Grade IV astrocytoma? Glioblastoma multiforme
Glioblastoma multiforme is: Grade IV astrocytoma
Adult or Childhood brain tumor: Glioblastoma multiforme? Adult
Common, highly malignant primary brain tumor with ~ 1 year median survival. Dx? Glioblastoma multiforme
What is a "common" way to refer to Glioblastoma multiforme? Butterfly glioma
Severe astrocytoma that can cross corpus callosum. Dx? Glioblastoma multiforme
- Astrocyte origin, GFAP (+) - "Pseudopalisading" What is the possible brain tumor? Glioblastoma multiforme
What is the characteristic of the astrocytes in Glioblastoma multiforme? GFAP (+); "Pseudopalisading" pleomorphic tumor cells border central aras of necrosis, hemorrhage, and/or microvascular proliferation
"Pseudopalisading" pleomorphic tumor cells border central areas of necrosis. Dx? Glioblastoma multiforme
What is the main cell proliferation in Glioblastoma multiforme? Astrocytes
What causes Glioblastoma multiforme to adopt the term "butterfly glioma"? The fact it can cross the corpus callosum, gives it a butterfly appearance
Where is a Glioblastoma multiforme most likely found? Cerebral hemispheres
Which primary adult brain tumor is found in the Cerebral hemispheres? Glioblastoma multiforme
Where do most often Oligodendroglioma appear? Frontal lobe
"Chicken-wire" capillary pattern. Brain tumor? Oligodendroglioma
What is origin cell of Oligodendroglioma? Oligodendrocytes
What is the histology of Oligodendrogliomas? "Fried egg" cells- round nuclei with creal cytoplasm. Often calcified
Which adult brain tumor appears in the frontal lobes? Oligodendroglioma
Adult or Childhood brain tumor: Oligodendroglioma? Adult
Adult or Childhood brain tumor: Meningioma? Adult
Adult or Childhood brain tumor: Hemangioblastoma? Adult
Adult or Childhood brain tumor: Pituitary adenoma? Adult
Which adult brain tumor is common, typically benign, more common in females than males? Meningioma
Most common location for Meningioma? Near surfaces of brain and in parasagittal region
Which is brain tumor is often seen with dural attachment? Meningioma
Which tumor is seen with a "tail" attached to the dura? Meningioma
Arachnoid cell origin brain tumor. Meningioma
Histology of a Meningioma: Spindle cells concentrically arranged in a whorled pattern; psammoma bodies
(+) Psammoma bodies brain tumor Meningioma
Spindle cells concentrically arranged in whorled pattern; (+) Psammoma bodies. Meningioma
Blood vessel oring adult brain tumor. Hemangioblastoma
Near surfaces fo brain and parasagittal regions. Meningioma
Hemangiomas are most often __________________. Cerebellar
What conditions are associated with Hemangioblastomas? von Hippel-Lindau syndrome, when found with retinal angiomas
What is a possible consequence produced by Hemangioblastomas Secondary polycythemia
How does a Hemangioblastoma cause secondary polycythemia? It produces Erythropoietin
What is the histology found in Hemangioblastomas? Closely arranged, thin-walled capillaries with minimal intervening parenchyma.
Adult or Childhood brain tumor: Schwannoma? Adult
What are the tow types of Pituitary adenoma? 1. Non-functioning (silent) 2. Hyperfunctioning (hormone producing)
What is meant by a Hyperfunctional Pituitary adenoma? Brain tumor that produces hormones
What is the most common hyperfunctional pituitary adenoma? Prolactinoma
What is the hormone consequence of the most common hyperfunctional pituitary adenoma? Hyperprolactinemia
What are rare, hyperfunctional pituitary adenomas? 1. Adenoma of somatotrophs (GH) --> acromegaly/gigantism 2. Adenoma of corticotrophs (ACTH) --> Cushing disease
What mass effect is seen with nonfunctional pituitary adenomas? Bitemporal hemianopsia, hypopituitarism, and headache
What structure is compressed by pituitary adenoma that causes bitemporal hemianopsia? Optic chiasm
The Optic chiasm is often compressed by which adult brain tumor? Nonfunctional pituitary adenoma
What is the normal presentation of Prolactinoma in women? Galactorrhea, amenorrhea, and decreased bone density due to suppression of estrogen.
What is the reason for the female clinical symptoms due to a Prolactinoma? Suppression of estrogen by increased prolactin
How is a prolactinoma clinically presented in men? Low libido and infertility
What is the non-surgical treatment of a Pituitary adenoma? Dopamine agonists
Dopamine agonist are used to treat what type of adult brain tumor? Pituitary adenoma
A transsphenoidal resection is a surgical treatment for: Pituitary adenoma
What are common dopamine agonists used in Pituitary adenoma treatment? Bromocriptine and Cabergoline
What is the location for a Schwannoma? Cerebellopontine angle
What brain tumor is commonly found in the Cerebellopontine angle? Schwannoma
What cranial nerves are involved in Schwannoma? CN VII and VIII
Vestibular Schwannoma is localized in: CN VIII in internal acoustic meatus
What brain tumor is located at Internal acoustic meatus? Vestibular Schwannoma
Bilateral Schwannomas are associated with what condition? NF-2
What is the origin cell for Schwannomas? Schwann cell
What are features that mark or indicate Schwann cell? S-100 (+), and Biphasic
Histology of Schwannoma: Dense, hypercellular areas containing spindle cells alternating with hypocellular, myxoid areas
Histology findings: Dense, hypercellular areas alternating with hypocellular, myxoid areas. Schwannoma histology
S-100 (+). Brain cancer? Schwannoma
List of childhood primary brain tumors: 1. Pilocytic astrocytoma 2. Medulloblastoma 3. Ependymoma 4. Craniopharyngioma 5. Pinealoma
Adult or Childhood brain tumor: Pilocytic astrocytoma? Childhood
Adult or Childhood brain tumor: Medulloblastoma? Childhood
Adult or Childhood brain tumor: Ependymoma? Childhood
Adult or Childhood brain tumor: Craniopharyngioma? Childhood
Adult or Childhood brain tumor: Pinealoma? Childhood
Low-grade astrocytoma in children. Pilocytic astrocytoma
What is the most common primary brain tumor in children? Pilocytic astrocytoma
Where is most often found a Pilocytic astrocytoma? Posterior fossa (cerebellum)
The Posterior fossa (cerebellum) is the most common location for which childhood primary brain tumor? Pilocytic astrocytoma
What is the cell of origin for Pilocytic astrocytoma? Glial cell
GFAP (+). Glial cell oring. Child. Dx? Pilocytic astrocytoma
Histologic findings in Pilocytic astrocytoma: - Rosenthal fibers - eosinophilic, corkscrew fibers
Rosenthal fibers are seen in which childhood brain malignancy? Pilocytic astrocytoma
What is the most malignant primary childhood brain tumor? Medulloblastoma
What is the most common location for a Medulloblastoma? Cerebellum
What structure may be compressed by a Medulloblastoma? 4th ventricle
What is the result of compression to the 4th ventricle by a Medulloblastoma? Noncommunicating hydrocephalus
What type of hydrocephalus is seen in Medulloblastoma? Noncommunicating hydrocephalus
From of primitive neuroectodermal tumor (PNET). Medulloblastoma
What are the important histological findings of a Medulloblastoma? Homer-Wright rosettes, small blue cells
Small blue cells found in Medulloblastoma histological view. Homer-Wright rosettes
(+) Homer-Wright rosettes. Dx? Medulloblastoma
"Drop metastases" to spinal cord. Medulloblastoma
What are the symptoms caused by the noncommunicating hydrocephalus often found in Medulloblastoma patients? Headaches and Papilledema
What is the most likely childhood brain tumor that involves or may cause 4th ventricle compression? Medulloblastoma
Where is an ependymoma most likely found? 4th ventricle
An autopsy of a deceased child shows a large mass in the 4th ventricle. Dx? Ependymoma
Ependymoma may cause ---> Hydrocephalus
How is the prognosis of a Ependymoma? Poor
Ependyma cell origin childhood brain tumor. Ependymoma
What is the main histological characteristic of an Ependymoma? Perivascular pseudorosettes
What, histological finding, is seen near the nucleus of Ependymoma cells? Rod-shaped blepharoplasts
What are the Blepharoplasts? Basal ciliary bodies near the nucleus of ependymal ells
Tumor cells arranged radially around a central vessel Perivascular pseudorosettes
What is the most common childhood supratentorial tumor? Craniopharyngioma
A Craniopharyngioma is often mistaken or misdiagnosed with a ___________________. Pituitary adenoma
What complication or symptoms do both, Craniopharyngioma and Pituitary adenoma, cause that may indicate why there are often mistaken by each other? Bitemporal hemianopsia
Which childhood tumor is derived from remnants of Rathke's pouch (ectoderm)? Craniopharyngioma
What is a key or featured histological finding of a Craniopharyngioma? Cholesterol crystal found in "motor-oil"-like fluid within tumor
Cholesterol crystal in what seems to be motor oil fluid. Dx? Craniopharyngioma
What is a Pinealoma? Childhood brain tumor of pineal gland
What is a common consequence of a Pinealoma? Parinaud syndrome
How does a Pinealoma causes Parinaud syndrome? Compression of tectum which presents with vertical palsy gaze
What is Parinaud syndrome? Compression of tectum leading to vertical gaze palsy
List of common compression compilation by a Pinealoma? 1. Parinaud syndrome 2. Obstructive hydrocephalus 3. Precocious puerbty in males
How does a Pinealoma cause Obstructive hydrocephalus? Compression of cerebral aqueduct
The compression of the cerebral aqueduct by a Pinealoma leads to development of: Obstructive hydrocephalus
How does Pinealoma cause precocious puberty in males? Increase B-hCG production
Which childhood primary brain tumor is similar to germ cell tumors? Pinealoma
A testicular seminoma can be said to be the ____________ of the brain tumors. Pinealoma
What are the deficits or symptoms seen with frontal lobe tumors? 1. One sided paralysis 2. Seizures 3. Defective memory 4. Impaired judgement 5. Personality changes
What are the common symptoms seen with Temporal lobe tumors? - Occasional seizures - Language disorders
Brain stem CNS tumors present what common symptoms? 1. Uncoordinated walk 2. Muscle weakness 3. Difficulty in speech 4. Drowsiness 5. Hearing loss
A person with a CNS tumor located in the cerebellum will likely experience the following symptoms: 1. Vomiting 2. Headache 3. Uncoordinated muscle movement 4. Problems in walking
Parietal lobe tumors/cancer will likely present the patient with: - Seizures - Speech disturbance - Loss ability to write
An occipital lobe tumor very likely will present with: Blindness and seizures
One sided paralysis due to CNS tumor, is most likely found in which lobe? Frontal lobe
What is the most common symptom of a Supratentorial tumor? Symptoms of raised ICP
Papilloedema, seizures, raised ICP, and focal neurological deficits, are seen in what type of brain tumors? Supratentorial tumors
Posterior fossa tumours main symptoms are: Nausea and vomiting
Which brain tumors are often seen with Pyramidal signs? Brain stem tumors
What are the top 3 symptoms of Brain stem tumors? 1. Abnormal gait and coordination difficulties 2. Cranial nerve palsies 3. Pyramidal signs
Spinal cord tumors main clinical symptom is: Back pain
What brain tumors are located in the Corpus callosum? Astrocytoma and Oligodendroglioma
Which brain tumors are located in the Cerebral hemisphere? Astrocytoma, Meningioma, Oligodendroglioma, and Ependymoma.
Brain tumors in the ventricles: Ependymoma, Choroid plexus papilloma, and Subependymoma
Where is the common location for a hemangioblastoma? Cerebellum
What is Aphasia? Higher-order language deficit
Inability to understand/produce/use language appropriately. Aphasia
What is the cause for Aphasias? Pathology in dominant cerebral hemisphere
A condition that affects the dominant cerebral hemisphere, that causes the patient to inappropriately verbally express. Aphasia
Which is the most commonly affected Dominant cerebral hemisphere in aphasia? Left (usually the dominant side)
What is Dysarthria? Motor inability to speak
Is Aphasia or Dysarthria the inability to produce movement in order to speak? Dysarthria
What are the two criteria tested or analyzed in Aphasias? Speech fluency and Comprehension
What are the main two categories in which aphasias are usually divided into? 1. Repetition impaired 2. Repetition intact
What specific language and speech characteristic is used to categorize the most significant types of aphasias? Repetition ability
List of the Repetition IMPAIRED aphasias: 1. Broca (expressive) 2. Wernicke (receptive) 3. Conduction 4. Global
Which repetition impaired aphasia have NON-fluent speech fluency? Broca and Global
Which is the only repetition impaired aphasia that has both affected, speech fluency and comprehension? Global aphasia
Broca area location Inferior frontal gyrus of frontal lobe
What area/structure is at the inferior frontal gyrus of frontal lobe? Broca area
How is a Broca aphasia patient commonly found (emotionally) during doctor's visits or therapy? Frustrated
A patient with a broken language, goes to doctor's office, but during the visit the patient, loses patience and acts extremely frustrated and agitated. Dx? Broca aphaia
Broca aphae is _______________________. Expressive
Wernicke aphasia is denominated a __________________ aphasia. Receptive
What type of aphasia is most likely indicated if it's described as an "expressive aphasia" with repetition impaired? Broca aphasia
Speech fluency = Nonfluent Comprehension = Intact Repetition = Impaired What is the most likely Dx? Broca aphasia
Speech fluency = Fluent Comprehension = Impaired Repetition = Impaired Wernicke's aphasia
How are the speech fluency and comprehension in a Wernicke's aphasia? Fluent speech but impaired or poor comprehension
Patients do not have insight. Aphasia? Wernicke's aphasia
Superior temporal gyrus of temporal lobe. Wernicke area
How is the "insight" of a Broca aphasia patient? Intact
What kind of aphasia is seen by damage to the Arcuate fasciculus? Conduction aphasia
What is the only deficit seen in Conduction aphasia? Repetition
Speech fluency = Fluent Comprehension = Intact Repetition = Impaired Conduction aphasia
If both areas, Broca and Wernicke areas, are affected, what is the most likely type of repetition impaired aphasia to be developed? Global aphasia
What are the two repetition impaired aphasias that develop due to damage to the Arcuate fasciculus? Conduction and Global aphasias
What is the key word in the name of aphasias that have INTACT repetition? Transcortical
If the aphasia in question has the word "Transcortical" it always depicts what characteristic? Repetition is INTACT
What are the 3 types of Repetition intact aphasias? 1. Transcortical motor 2. Transcortical sensory 3. Transcortical, mixed
Speech fluency = Nonfluent Comprehension = Intact Repetition = Intact Transcortical motor aphasia
Affects frontal love around Broca area, but Broca area is spared. Dx? Transcortical motor aphasia
What area is spared from damage in Transcortical motor aphasia? Broca area
What areas are affected in Transcortical motor aphasia? Frontal lobe around Broca area
Speech fluency = Fluent Comprehension = Impaired Repetition = Intact Transcortical sensory aphasia
Which aphasia affects the temporal lobe around the Wernicke area, but Wernicke area is actually spared (non affected)? Transcortical sensory aphasia
Speech = Nonfluent Comprehension = Impaired Repetition = Intact Transcortical, mixed aphasia
What areas are spared from damage in Transcortical, mixed aphasia? Broca and Wernicke areas and Arcuate fasciculus remain intact.
What is affected in order to develop Transcortical, mixed aphasia? Watershed areas
Watershed areas of brain are affected. What pathology is associated or develope due to this effect? Transcortical, mixed aphasia
When is comprehension affected in aphasias? The Wernicke area or its surroundings are affected
When is Speech fluency affected in aphasias? Broca area or its surroundings are affected/damaged
What is the definition of aneurysms? Abnormal dilation of an artery due to weakening of vessel wall
Abnormal dilation of an artery due to weakening of vessel wall Aneurysm
What are the two main types of aneurysms? 1. Saccular aneurysm 2. Charcot-Bouchard microaneurysm
What is another way to name a Saccular aneurysm? Berry aneurysm
Where do Berry (Saccular) aneurysms occur? Bifurcations of the circle of Willis
Where is the MC site for a Berry aneurysm? Junction of Anterior Communicating artery (ACom) and ACA.
What are two conditions associated with development of Berry aneurysms? ADPKD and Ehlers-Danlos syndrome
What are secondary (minor) associated risk factors of Berry aneurysm development? Advance age, hypertension, smoking, African-American race
Which race is most commonly affected by Berry aneurysms? African-Americans
Pathway in which a Saccular aneurysm develops focal neurological deficits: Rupture of Saccular aneurysm --> Subarachnoid hemorrhage leading to focal neurological deficits
What common ways patients describe the symptoms of Subarachnoid hemorrhage? 1. "worst headache of my life", 2. "thunderclap headache"
The direct compression of the Anterior Communicating artery by a Saccular aneurysm produces the following symptoms: - Bitemporal hemianopia; - Visual acuity deficits - Rupture --> ischemia in ACA distribution leading to contralateral lower extremity hemiparesis, and sensory deficits
What is the result of ACom rupture because of a Berry aneurysm in the ACA? Contralateral lower extremity hemiparesis and sensory deficits
What is the result of MCA distribution obstruction due to a Berry aneurysm ruptures? Contralateral upper extremity and lower facial hemiparesis, and sensory deficits
PCom compression due to direct compression of a Berry aneurysm ---> Ipsilateral CN III palsy leading to mydriasis; and possible ptosis, "down and out" eye.
What are arteries commonly directly compressed by a Saccular aneurysms? 1. ACom 2. MCA 3. PCom
What is a common aneurysm, associated with chronic hypertension? Charcot-Bouchard microaneurysm
What small vessels are commonly affected by Charcot-Bouchard microaneurysm? Lenticulostriate arteries in basal ganglia and Thalamus
What is a common severe complication of Charcot-Bouchard aneurysms? Lacunar strokes
What is a common cause of Lacunar strokes? Charcot-Bouchard microaneurysms
Seizures are characterized by: Synchronized, high-frequency neuronal firing
What are the two main categories of Seizures? 1. Partial (focal) seizures 2. Generalized seizures
What are partial (focal) seizures? Affect single area of the brain. Most commonly originate in medial temporal lobe.
What are the types of Partial (focal) seizures? 1. Simple partial seizures 2. Complex partial seizures
Description of Simple partial seizures? - Consciousness intact - Motor, sensory, autonomic, and psychic
Which type of focal seizure is characterized with impaired consciousness, and automatisms? Complex partial seizures
What conditions (pathologies) are associated with Partial (focal) seizures? 1. Epilepsy 2. Status epilepticus
What is Epilepsy? A disorder of recurrent seizures
What is Status epilepticus? Continuous (> 5 mins) or recurring seizures that may result in brain injury
Condition of recurrent seizures less than 5 minutes, that result in brain injury. Status epilepticus
Diffuse seizures = Generalized seizures
What are the types of Generalized seizures? 1. Absence 2. Myoclonic 3. Tonic-clonic 4. Tonic 5. Atonic
What is another way to name an absence seizure? Petit mal
3 Hz spike-and-wave discharges, no postictal confusion, and blank stare. Absence seizure
What type of generalized seizures is featured by a "blank stare"? Absence seizure
Description of Myoclonic seizures: Quick, repetitive jerks
What is another way to refer to a Tonic-clinic seizure? Grand mal
If a vignette describes a "grand mal" seizure, it refers to: Tonic-clonic seizure
What is the description of and Tonic-clonic seizure? Alternating stiffening and movement
Person fall on floor and has a pattern of body stiffening and movement alternation. Dx? Tonic-clonic seizure
What is the term "tonic" refer in seizures? Stiffening
Description Atonic seizure? "drop" seizures (falls to floor); commonly mistaken for fainting
"drop" seizures Atonic seizures
What is the MCC of elderly seizures? Stokes
What is another way to refer infection seizure? Febrile seizure
What is a headache? Pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures.
What types of headaches are more common in males? Cluster headaches
What are the types of headaches important for USMLE? 1. Cluster 2. Tension 3. Migraine
Which type (s) of headache are unilateral? Cluster and Migraine
Which type of headache is bilateral? Tension
What is the duration of a Cluster headache? 15 min - 3 hour; repetitive
What is the description of a Cluster headache? - Excruciating periorbital pain with lacrimation and rhinorrhea - (+/-) Horner syndrome - More common in males
What is the acute treatment of a Cluster headache? Sumatriptan, 100% oxygen
What is the prophylaxis medication for cluster headache? Verapamil
What is the average duration of a Tension headache? > 30 minutes
Description of Tension headache - Steady, "band-like" pain. - No photophobia or phonophobia - No aura
What are the common drugs used for acute tension headache? Analgesics, NSAIDs, and acetaminophen
What medication is commonly used to treat chronic tension headaches? Amitriptyline
Unilateral, intense 4-72 hour headache. Migraine
What is the duration of a migraine? 4 - 72 hours
What is the description of a Migraine? - Pulsating pain with nausea, photophobia, or phonophobia - (+/-) have "aura"
What is the cause for a migraine? Irritation of CN V, meninges, or blood vessels
What serum substances are secreted in the pathogenesis of a migraine? Substance P, calcitonin gene-related peptide, and vasoactive peptides
What is the acute treatment of a migraine? NSAIDs, triptans, and dihydroergotamine
Prophylaxis of a migraine: Lifestyle changes, B-blockers, amitriptyline, topiramate, and valproate.
What is a common mnemonic of migraine characteristics? POUND Pulsatile One-day duration Unilateral Nausea Disabling
What are less common causes of headache? Subarachnoid hemorrhage, meningitis, hydrocephalus, neoplasia, and giant cell (temporal) arteritis.
A cluster headache is often compared with what other pathology? Trigeminal neuralgia
Producers repetitive, unilateral, shooting pain in the distribution of CN V. Trigeminal neuralgia
What is the first line of therapy for Trigeminal neuralgia? Carbamazepine
What can trigger Trigeminal neuralgia? Chewing, talking, touching certain parts of the face
What is "Akathisia"? Restlessness and intense urge to move
Restlessness and intense urge to move. Akathisia
Possible side effect of Parkinson treatment Akathisia
What is Asterixis? Extension of wrists causes "flapping" motion
What pathologies and/or conditions are associated with Asterix? Hepatic encephalopathy, Wilson disease, and other metabolic derangements.
What are two common movement disorders associated with lesion of the Basal ganglia? Athetosis and Chorea
What is Athetosis? Slow, snake-like, writhing movements; especially in the fingers
Slow, snake-like, writhing movements in the fingers Athetosis
Definition of Chorea: Sudden, jerky, purposeless movements
Sudden, jerky, and purposeless movements Chorea
What conditions are seen with Chorea? Huntington disease and Rheumatic fever
Dystonia is: Sustained, involuntary muscle contractions
An involuntary muscle contraction that is sustained for short period of times. Dystonia
Associated conditions that may produce Dystonia: Writer's cramp, blepharospasm, and torticollis
"Writer's cramp" is an example of what type of movement disorder? Dystonia
What is Essential tremor? High-frequency tremor with sustained posture, worsened with movement or when anxious
High-frequency tremor with sustained posture, that is worst in movements of anxiety or movement. Essential tremor
What is the common treatment that individual may choose to treat Essential tremor? Alcohol, since it decreases tremor amplitude
Why is common to find alcoholism in a patient with Essential tremor? Alcohol- it decreases amplitude of the tremor
What is the medically relevant (not alcohol) treatment for Essential tremor? Non-selective B-blockers, and primidone.
Sudden, wild flailing of 1 arm, +/_ ipsilateral leg. Hemiballismus
What is Hemiballismus? Sudden, wild flailing of one arm, and possible the ipsilateral leg
Where is the lesion of Hemiballismus? Contralateral subthalamic nucleus
Contralateral or Ipsilateral lesion is seen in Hemiballismus? Contralateral
What type of movement disorder is seen with Cerebellar dysfunction? Intention tremor
What is Intention tremor? Slow, zigzag motion when pointing/extend toward a target
Slow, zigzag motion when pointing/extending toward a target Intention tremor
A person that extends on purpose the arm pointing to a target is seen with slow, zigzag movements of such extremity. Dx? Intention tremor
What is the definition of Myoclonus? Sudden, brief, uncontrolled muscle contraction
If the muscle contraction is sudden and brief, it is _______________. Myoclonus
What is the difference between the muscle contraction, in odr to be either dystonia or myoclonus? Brief contraction is myoclonus Sustained contraction is dystonia
What are two common examples of Myoclonus? Jerks and hiccups
Which organ failures are common to develop myoclonus? Liver and kidneys
How is Resting tremor defined? Uncontrolled movement of distal appendages; tremor alleviated by intentional movement.
What area is affected in Parkinson disease that leads to development of Resting tremor? Substantia nigra
Which type of tremor occurs at rest? Resting tremor
"Pill-rolling tremor" of Parkinson disease Resting tremor
How is Resting tremor alleviated? Producing intentional tremor
When is Restless legs syndrome the worst? During rest or nighttime
What are associated conditions that are seen with Restless legs syndrome? Iron deficiency and CKD
What is the treatment for Restless legs syndrome? Dopamine agonists
Which movement disease or condition is treated with Dopamine agonists, such as ropinirole and Pramipexole? Restless legs syndrome
What are two common Dopamine agonists used in Restless legs syndrome? Pramipexole and Ropinirole
Pathophysiology of FEVER: Cytokine activation during inflammation, such in an infection
What is the pathophysiology of a Heat stroke? Inability of body to dissipate heat
Incapacity to get rid of body heat. Heat stroke
What is the temperature for fever? < 40 C
> 40 C. Fever or Heat stroke? Heat stroke
What are the possible complications of fever? Febrile seizure
List of complication from Heat Stroke: - CNS dysfunction - End-organ damage - Acute respiratory distress syndrome - Rhabdomyolysis
What are the common drugs used to treat Fever? 1. Acetaminophen or ibuprofen for comfort 2. Antibiotic therapy if indicated
How is Heat Stroke managed? Rapid external cooling, rehydration and electrolyte correction
Decrease in cognitive ability, memory, or function with intact consciousness. Neurodegenerative disorder
What is the term given to dementia caused by depression? Pseudodementia
What mood disorder must be rule-out as the cause of dementia? Depression
What are some reversible causes of dementia? Hypothyroidism, vitamin B12 deficiency, neurosyphilis, normal pressure hydrocephalus, and depression.
What is the histologic and gross findings in Parkinson disease? 1. Loss of dopaminergic neurons of substantia nigra pars compacta 2. Lewy bodies: composed of a-synuclein
What are Lewy bodies composed of? a-synuclein
What are Lewy bodies? Intracellular eosinophilic inclusions found in Parkinson disease
What is MPTP? Contaminant in illegal drugs, is metabolized to MPP+, which is toxic to substantia nigra
What is a common toxic metabolic to the substantia nigra? MPP+, a metabolite of MPTP
TRAPSS Tremor Rigidity Akinesia Postural instability Shuffling gait Small handwriting
Medical term for small handwriting Micrographia
Autosomal dominant trinucleotide (CAG)n. Dx? Huntington disease
What is the gene involved in Huntington disease? Trinucleotide expansion of CAGn in the huntingtin (HTT) gene on chromosome 4
Which chromosome is affected in Huntington's disease? Chromosome 4
What is the common age range of onset of Huntington's symptoms? 20-50 years old
What are the symptoms seen with Huntington disease? Chorea, athetosis, aggression, depression, dementia.
Caudate loses ACh and GABA Huntington disease
What genetic phenomenon is associated with Huntington disease? Anticipation
Pathogenesis of Huntington's disease: Atrophy of caudate and putamen with ex vacuo ventriculomegaly
Neurotransmitter levels in Huntington disease: Increase dopamine, and decrease ACh and GABA
How do neurons "die" in Huntington disease? Via NMDA-R binding and glutamate excitotoxicity
GAGn repeat. Dx? Huntington disease
Which NTs are decreased in Huntington disease? ACh and GABA
Which neurotransmitter is elevated in Huntington disease? Dopamine
What is the MCC of dementia in the elderly? Alzheimer disease
Which trisomy condition is associated with a higher risk of developing Alzheimer disease? Down syndrome
Why are Down syndrome patients at higher risk of eventually developing Alzheimer disease? APP is located in chromosome 21
What neurotransmitter is decreased in Alzheimer's disease? ACh
What are some associated altered proteins of Alzheimer disease? 1. ApoE-2 2. ApoE-4 3. APP, presenilin-1, presenilin-2
What protein is associated with a decrease risk of sporadic form of Alzheimer disease? ApoE-2
A person with an altered ApoE-4 protein ----> Increase risk of sporadic form of Alzheimer disease
What proteins are associated with familial forms with earlier onset of Alzheimer disease? APP, presenilin-1, and presenilin-2
Widespread cortical atrophy, especially hippocampus. Narrowing gyri and widening of sulci. Gross findings of Alzheimer disease
What are some histological findings in Alzheimer disease? Senile plaques in gray matter: extracellular B-amyloid core
What are the Neurofibrillary tangles found in histology of Alzheimer disease patient? Intracellular, hyperphosphorylated tau protein = insoluble cytoskeletal elements
What part of the brain is most affected by Alzheimer disease? Hippocampus
What neurodegenerative condition is associated with Hirano bodies? Alzheimer disease
What are the intracellular rods found in Alzheimer disease? Hirano bodies
What are Hirano bodies? Intracellular eosinophilic proteinaceous rods in hippocampus
Where in the brain are Hirano bodies found? Hippocampus
What is the old name for Frontotemporal dementia? Pick disease
What is the new name of Pick disease? Frontotemporal dementia
What are the histological findings of Frontotemporal dementia? Inclusions of hyperphosphorylated tau or ubiquitinated TDP-43
Histological findings: Hyperphosphorylated Tau proteins and Ubiquitinated TDP-43. Dx? Frontotemporal dementia
What are clinical feurs to Lewy body dementia? Visual hallucinations, dementia with fluctuating cognition/alertness, REM sleep behavior disorder, and parkinsonism.
Where are Lewy bodies are primarily found? In cortex
What neurologic disorder is associated with REM sleep behavior disorder? Lewy body dementia
When is it called Lewy body dementia? If cognitive and motor symptom onset is < 1 year apart
If the cognitive deficit in is over a year apart form motor deficit, it is not longer considered Lewy body dementia, instead it is considered: Secondary to Parkinson disease
What is the cause of Vascular dementia? Result of multiple arterial infarcts and/or chronic ischemia
What is the second MCC of dementia in elderly? Vascular dementia
Step-wise decline in cognitive ability with late-onset memory impairment. Vascular dementia
MRI or CT show multiple cortical and/or subcortical infarcts. Dx? Vascular dementia
What do the images of a MRI or CT of vascular dementia patient most likely show? Multiple cortical and/or subcortical infarcts
What is Creutzfeldt-Jakob disease? Rapidly progressive dementia with myoclonus and ataxia
What is commonly seen in EEG of CJD? Periodical sharp waves
Important CSF finding in CJD? Incread 14-3-3 protein
Elevated 14-3-3 protein in CSF. Dx? Creutzfeldt-Jakob disease
- Rapid progressive dementia, + - "Startle myoclonus", + - Ataxia. Dx? Creutzfeldt-Jakob disease
Spongiform cortex. Dx? Creutzfeldt-Jakob disease
Prion neurodegenerative condition. Creutzfeldt-Jakob disease
What is another name for Idiopathic intracranial hypertension? Pseudotumor cerebri
Elevated ICP with no apparent cause on imaging. Dx? Idiopathic intracranial hypertension
What are conditions the cause increased ICP with no imaging evidence? Hydrocephalus, and obstruction of CSF outflow
What are common risk factor for Idiopathic intracranial hypertension? Female gender, Tetracycline, Obesity, vitamin A excess, and Danazol
What the common physical findings seen with Idiopathic intracranial hypertension? Headache , tinnitus, diplopia, no change in mental status
What is the treatment of Pseudotumor cerebri? Weight loss, acetazolamide, invasive procedures for refractory cases.
What cause the papilledema seen in Pseudotumor cerebri? Impaired optic nerve axoplasmic flow
What is accomplished by performing a LP on a patient with Idiopathic intracranial hypertension? Reveals elevated opening pressure and provides temporary headache relief.
What is the pathogenesis of Hydrocephalus? Increased CSF volume leads to ventricular dilation and possible increase in ICP
How are types of hydrocephalus mainly divided into? Communicating, Non-communicating,and Hydrocephalus mimics
WHat are the two types Communicating hydrocephalus? 1. Communicating hydrocephalus 2. Normal pressure hydrocephalus
What is the cause of Communicating hydrocephalus? Decreased CSF absorption by arachnoid granulations leading to development of elevated ICP, papilledema, and herniation
Arachnoid scarring post-meningitis is a common cause for: Communicating hydrocephalus
What population is most affected by normal pressure hydrocephalus (NPH)? Elderly
CSF pressure elevated only episodically; does not result in increased subarachnoid space volume; expansion of the ventricles. Dx? Normal Pressure Hydrocephalus
What is the result of the expansion of the ventiluces in NPH? Distorts the fibers of the corona radiata leading to development of trial do urinary incontinence, gait apraxia, and cognitive dysfunction.
What is the common triad associated with NPH? 1. Urinary incontinence 2. Gait apraxia 3. Cognitive dysfunction
What is another way to describe the gait apraxia seen in NPH patient? Magnetic gait
What part is distorted in NPH ventricle expansion leading to developing of its famous clinical triad? Fibers of the corona radiata
What is the treatment that often lead to reversivion of cysmtpos in NPH? CSF shunt placement
What type of hydrocephalus is classified as Obstructive? Non-communicating hydrocephalus
Caused by structural blockage of CSF circulation within ventricular system Pathogenesis of Non-communicating hydrocephalus
What are examples that cause the obstruction in Non-communicating hydrocephalus? - Stenosis of aqueduct of Sylvius - Colloid cyst blocking foramen of MOnro - Tumor
Ex vacuo ventriculomegaly Appearance of increased CSF on imaging, but is actually due to decreased brain tissue and neuronal atrophy
Apparent increase in CSF + Normal ICP + (-) NPH triad. Dx? Ex vacuo ventriculomegaly
What condition mimics a Hydrocephalus? Ex vacuo ventriculomegaly
Which conditions are often associated with Ex vacuo ventriculomegaly? Alzheimer's disease, advanced HIV, Pick disease, and Huntington's disease
Why are Huntington and Alzheimer's, and other neurodegenerative conditions associated with Ex vacuo ventriculomegaly? Decreased brain tissue and nurutonal atrophy
What is Multiple sclerosis? Autoimmune inflammation and demyelination of CNS with subsequent axonal damage.
Autoimmune inflammation and demyelination of CNS with subsequent axonal damage. Multiple sclerosis
What are the general features presented in Multiple sclerosis? 1. Acute optic neuritis 2. Brain stem/cerebellar syndromes 3. Pyramidal tract weakness 4. Spinal cord syndromes
Description Acute Optic neuritis in MS: Painful unilateral visual loss associated with Marcus Gunn pupil
What are the clinical symptoms of the brainstem/cerebellar syndromes seen with Multiple sclerosis? Diplopia, ataxia, scanning speech, intention tremor, nystagmus/INO.
INO deficit is often associated with _________ ___________. Multiple sclerosis
What is Lhermitte phenomenon? Electric shock-like sensation along spine on neck flexion
What neurological autoimmune condition is associated with Lhermitte phenomenon? Multiple sclerosis
What physical condition may exacerbate symptoms of Multiple sclerosis? Increased body temperature
What is the common pattern or characteristic of MS clinical course? Relapsing and remitting
Which population are most affected with Multiple sclerosis? Women in their 20s and 30s; more common in Caucasians living away from the equator
Oligoclonal bands are diagnostic for what condition? Multiple sclerosis
What is found in CSF sample of a Multiple sclerosis patient? Elevated IgG level aodn myelin basic protein
What is the gold standard test/imagining procedure for Multiple sclerosis? MRI
What are the findings in MRI of a MS patient? Periventricular plaques
MRI (+) periventricular plaques Multiple sclerosis
What are the periventricular plaques found in MRI of MS? Areas of Oligodendrocyte loss and reactive gliosis
Multiple white matter lesions disseminated in space and time. Dx? Multiple sclerosis
Multiple sclerosis affects white or gray matter? White matter
What is used to treat acute flares of MS? IV steroids
What is the treatment (chronic) for Multiple sclerosis? Stop relapses and halt/slow progression with disease-modifying therapies
What are common drugs denominated as Disease-modifying therapies? B-interferon, glatiramer, and Natalizumab
What is another name for Osmotic demyelination syndrome? Central pontine myelinolysis
What is Osmotic demyelination syndrome? Massive axonal demyelination in pontine white matter
What is the cause for Osmotic demyelination syndrome? Secondary to rapid osmotic changes, most commonly iatrogenic correction of hyponatremia but also rapid shifts of other osmolytes
Clinical features of Osmotic demyelination syndrome? Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness
What is a possible severe complication of Osmotic demyelination syndrome? "Locked-in syndrome"
Problems arise from correcting serum Na+ too fast or too slow? Too fast
Excessively rapid correction of low serum Na+ to high serum Na+ leads to development of: Osmotic demyelination syndrome
Serum Na+ form high to low rapid correction lead to: Cerebral edema/herniation
Massive axonal demyelination in pontine white matter secondary to rapid osmotics changes, especially rapid correction of low serum Na+ to high serum Na+? Osmotic demyelination syndrome
What is the most common subtype of Guillain-Barre syndrome? Acute inflammatory demyelinating polyradiculopathy
What is acute inflammatory demyelinating polyradiculopathy? Autoimmune conditions associated with infections and motor fibers likely due to molecular mimicry, inoculation, and stress, but no definitive link to pathogens
What infection is associated to Acute inflammatory demyelinating polyradiculopathy? Campylobacter jejuni, virus (Zika) that destroy Schwann cells by inflammation and demyelination of peripheral nerves III-XII
What is the clinical presentation of Acute inflammatory polyradiculopathy, common subtype of GBS? 1. Symmetric ascending muscle weakness/paralysis and depressed /absent DTRs beginning in lower extremities 2. Facial paralysis (MC bilaterally) 3. Respiratory failure 4. +/- Autonomic dysregulation and/or sensory abnormalities
What is albuminocytologic dissociation? Increased CSF protein with normal cell count
What conditions is seen with albuminocytologic dissociation? Acute inflammatory demyelinating polyradiculopathy
What is the treatment for Acute inflammatory demyelinating polyradiculopathy? Disease-modifying treatment with plasmapheresis, and IV immunoglobulins
What is Acute disseminated (postinfectious) encephalomyelitis? Multifocal inflammation and demyelination after infection or vaccination
What is the common clinical presentation of Acute disseminated encephalomyelitis? Rapidly progressive multifocal neurological symptoms and altered mental status.
What is the common name for Hereditary motor an sensory neuropathy? Charcot-Marie-Tooth disease
What is Charcot-Marie-Tooth disease? Group of progressive hereditary nerve disorders related to the detective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath.
Defective production of proteins involved in the structures and function of peripheral nerves or myelin sheath. Dx? Charcot-Marie-Tooth disease
The defective protein in Charcot-Marie-Tooth disease lead to abnormal structure and function of which neurologic structure? Peripheral nerves and myelin sheath
What is a clinical relevant feature of Charcot-Marie-Tooth disease? Foot deformities
What are the common foot deformities in CMT disease? Pes cavus, and hammer toe
Mode of inheritance of Charcot-Marie-Tooth disease? Autosomal dominant
What are the symptoms seen in Charcot-Marie-Tooth disease? 1. Foot deformities 2. Lower extremity weakness, and 3. Sensory deficits
What is and what causes the most common type of Charcot-Marie-Tooth disease? CMT1A, is caused by PMP22 gene duplication
Duplication of gene PMP22 leading to synthesis of CMT1A. Dx? Charcot-Marie-Tooth disease
Demyelination of CNS due to destruction of oligodendrocytes secondary to JC virus infection. Dx? Progressive multifocal leukoencephalopathy
What type of patients is PML encephalopathy often seen? AIDS
What is the clinical course often seen by JC virus induced PML? Rapidly progressive and most often fatal
What areas of the brain are most commonly affected by PML? Parietal and occipital areas
What therapies or medication increase firsl of developing PML by JC viral infection? Natalizumab and Rituximab
What is a possible severe complication in AIDS patient by the reactivation of latent JC virus infection? Progressive multifocal leukoencephalopathy
Krabbe disease, Metachromatic leukodystrophy, and adrenoleukodystrophy, are examples of: Demyelinating disorders
List of Neurocutaneous disorders: 1. Sturge-Weber syndrome 2. Tuberous sclerosis 3. Neurofibromatosis type 1 4. Neurofibromatosis type 2 5. von Hippel-Lindau disease
What is another name for Sturge-Weber syndrome? Encephalotrigeminal angiomatosis
What is the cause of Sturge-Weber syndrome? Congenital, non-inherited, developmental anomaly of neural crest derivatives due to somatic mosaicism for an activating mutation in one copy of the GNAQ gene
What causes the "stain in face" in a patient with Sturge-Weber syndrome? Small (capillary-seized) blood vessels
What is the port-wine stain of the face in a Sturge-Weber syndrome? Nevus flammeus, a non-neoplastic "birthmark" in CN V1/V2 distribution
What are the clinical features of Sturge-Weber syndrome? 1. Port-wine stain of the face 2. Ipsilateral leptomeningeal angioma --> seizures/epilepsy 3. Episcleral hemangioma leading to increased IOP --> early-onset glaucoma
What is the affected gene in Sturge-Weber syndrome? GNAQ gene
What is the result of the elevated IOP of Sturge-Weber syndrome? Glaucoma
TSC1 mutation on chromosome 9 or TSC2 mutation on chromosome 16. Dx? Tuberous sclerosis
What are features of Tuberous sclerosis? - Hamartomas in CNS and skin - Angiofibromas - Mitral regurgitation - Ash-leaf spots - Cardiac Rhabdomyoma - Autosomal dominant inheritance - Mental retardation - Renal Angiomyolipoma - Seizures - Shagreen patches
What malignancies or tumors have increased incidence in Tuberous sclerosis, but not are part of the disorder? Subependymal giant cell astrocytomas and Ungual fibromas
Hamartomas in CNS and skin. Dx? Tuberous sclerosis
What kind of murmur is seen in Tuberous sclerosis? Mitral regurgitation
What AD neurocutaneous disorder is associated with cardiac rhabdomyoma and Ash-leaf spots? Tuberous sclerosis
What renal tumors are seen in Tuberous sclerosis? Renal angiomyolipoma
Shagreen patches are seen in : Tuberous sclerosis
What type of skin lesions or "stains" are seen in Tuberous sclerosis? Ash-leaf spots and Shagreen patches
How else is Neurofibromatosis type I? Recklinghausen disease
What chromosome of is affected in NF I? Chromosome 17
What are the most significant features of NF I? 1. Cafe-au-lait spots 2. Cutaneous neurofibromas 3. Optic gliomas 4. Pheochromocytomas 5. Lisch nodules
What condition is associated with Lisch nodules? Neurofibromatosis type I
What is Lisch nodules? Pigmented iris hamartomas
What are main clinical features of Neurofibromatosis type II? 1. Bilateral acoustic schwannomas 2. Juvenile cataracts 3. Meningiomas 4. Ependymomas
Which neurocutaneous conditions is associated with Bilateral acoustic schwannomas? Neurofibromatosis type II
What are the associated brain tumors of NF II? 1. Acoustic Schwannomas 2. Meningiomas 3. Ependymomas
Deletion of VHL gene of chromosome 3p. Dx? von Hippel-Lindau disease
What is the role of pVHL? Ubiquinates hypoxia-inducible factors 1
What are the characteristics of vHL disease? Numerous tumors, both benign and malignant
What mnemonic is sued by von Hippel-Lindau disease? HARP: - Hemangioblastomas with hyperchromatic nuclei in retina, brain stem, cerebellum, and spine - Angiomatosis - Bilateral Renal Carcinomas - Pheochromocytomas
Which organs and tissues develop hemangioblastomas in vHL disease? Retina, brain stem, cerebellum, and spine
What is the associated angiomatosis developing in vHL disease? Cavernous hemangiomas in skin, mucosa, and other organs
Bilateral renal carcinomas + Pheochromocytomas + Hemangioblastomas. Dx? von Hippel-Lindau disease
What is the consequence of frontal lobe lesion? Disinhibition and deficits in concentration, orientation, judgement
What is a possible secondary result of frontal lobe lesion? Reemergence of primitive reflexes
What kind of brain lesion may lead to reemerge of primitive reflexes? Frontal lobe
Disinhibition and deficits in concentration, orientation, and judgement is caused aftera ___________ ____________ lesion. Frontal lobe lesion
What are the consequences Frontal eye fields lesions? Eyes look toward (destructive) side of lesion. In seizures (irritative), eyes look away from side of the lesion
Is it classified as destructive or irritative, a frontal eye field lesion, if the eyes look to the side of lesion? Destructive
Irritative frontal eye field lesion: Seizures, eyes look away from side of the lesion
What are the two types of Frontal eye field lesions? Destructive and Irritative
How are the eyes deviated in a irritative frontal eye field lesion? Away from the side of lesion
If the eyes of a patient with a frontal eye field lesions are deviated toward the side of the lesion, is it a destructive or irritative injury? Destructive
Consequence of Paramedian pontine reticular formation (PPRF) lesion? Eyes look away from side of lesion
What is an example of an Paramedian Pontine Reticular formation lesion? Ipsilateral gaze palsy
What is Ipsilateral gaze palsy? The inability to look toward side of lesion due to PPRF lesion
Which area of the brain is injured in Internuclear Ophthalmoplegia? Medial longitudinal fasciculus
Injured Medial Longitudinal fasciculus lead to development of: Internuclear ophthalmoplegia
What is Internuclear ophthalmoplegia? Impaired adduction of ipsilateral eye + nystagmus of contralateral eye with abduction
What are the two main clinical pathological components of Internuclear Ophthalmoplegia? 1. Impaired adduction if ipsilateral eye 2. Nystagmus of contralateral eye with abduction
What conditoin is often associated with injury to the MLF? Multiple Sclerosis
What is the ophthalmic condition associated with MS? Internuclear ophthalmoplegia
Which area of the brain is damaged or injured in Gerstmann syndrome? Dominant parietal cortex
What condition is seen to develop by injury to the dominant parietal cortex? Gerstmann syndrome
What are the clinical consequences of Dominant parietal cortex injury? Agraphia, acalculia, finger agnosia, left-right disorientation
A person with trouble writing, simple calculations, and not seem to recognise fingers. Dx? Gerstmann syndrome
Male accountant that after a severe car accident develops inability to carry simple mathematical calculations. What is the most likely area of the brain that was injured? Dominant parietal cortex
What condition is often seen in a person that can't distinguish the LEFT Index finger, by side or name? Gerstmann syndrome
What are the clinical consequences of lesion to the Non-dominant parietal cortex? Agnosia of the contralateral side of the world
Ignoring the right side of the world, is a result of: Left sided non-dominant parietal cortex lesion
What is the syndrome developed by injury to the non-dominant parietal cortex of the brain? Hemispatial neglect syndrome
Hemispace neglect syndrome is due to: Damage to Non-dominant parietal cortex
Are the clinical consequences of Non-dominant parietal cortex injury, ipsilateral or contralateral? Contralateral
What are the clinical signs or consequences of the Hippocampus? Anterograde amnesia
What is anterograde amnesia? Inability to make new memories
Inability to create or make new memories Anterograde amnesia
What area of the brain is injured if the patient develops anterograde amnesia? Hippocampus
What are the clinical features seen in injured basal ganglia? Tremor at rest, chorea, and athetosis
Which conditions are associated with Basal ganglia damage or lesion? Parkinson disease and Huntington disease
Which part of area is damaged or with lesion in Parkinson's or Huntington's disease? Basal ganglia
What is the main consequence of Subthalamic nucleus damage? Contralateral hemiballismus
What ishte result of right-sided Subthalamic nucleus damage? Left side hemiballismus
Contralateral or Ipsilateral, the hemiballismus caused by damage to the Subthalamic nucleus? Contralateral
Contralateral hemiballismus is probably due to: Injured Subthalamic nucleus
What is the main associated syndrome due to lesion to the Mammary bodies? Wernicke-Korsakoff syndrome
What are the clinical characteristics of Wernicke-Korsakoff syndrome? Confusion, Ataxia, Nystagmus Ophthalmoplegia Memory loss (anterograde and retrograde), Confabulation, and, Personality changes
What type of memory loss is seen in Wernicke-Korsakoff syndrome? Anterograde and Retrograde amnesia
Alcoholic patient in ER severely confused, difficulty walking, with no memory of the reason he was in the park, and creating a ever changing story. Dx? Wernicke-Korsakoff syndrome
What part of the brain is injured n Wernicke-Korsakoff syndrome? Mammillary bodies
What is the associated syndrome with lesioned Amygdala? Kluver-Bucy syndrome
What are the key features of Kluver-Bucy syndrome? Hyperphagia, hypersexuality, and hyperorality
Obese woman with Hx of multiple STIs and a online-channel for adults in which practices oral sex to multiple men. What type of brain physical damage can explain her risky behavior? Lesion to amygdala developing Kluver-Bucy syndrome
What viral infection-condition is associated with Kluver-Bucy syndrome? HSV-1 encephalitis
What important condition is due to Dorsal midbrain injury? Parinaud syndrome
What is the Parinaud syndrome? Vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence-retraction nystagmus
What palsy is seen in Parinaud syndrome? Vertical gaze palsy
Vertical gaze palsy + lid retraction + dorsal midbrain lesion. Dx? Parinaud syndrome
What events or conditions can provoke an lesion to the Dorsal midbrain? Stroke, hydrocephalus, and pinealoma.
What area of the brain may result damaged in a person with a Pinealoma? Dorsal midbrain
What brain area is injured in Parinaud syndrome? Dorsal midbrain
What is seen in Reticular activating system (midbrain)? Reduced levels of arousal and wakefulness
A person in coma, is seen what kind of brain lesion (area)? Reticular activating system (midbrain)
What are the most common consequences of lesion of the Cerebellar hemisphere? Intention tremor, limb ataxia, and loss of balance
Damage to the cerebellum causes what type of deficits? Ipsilateral
A person with damage to right side of cerebellum most likely will fall ---> Toward side of lesion (right side)
Cerebellar hemispheres are _________________ located. Laterally
A person with tendency to fall to right rise, most likely present what kind of cerebellar hemisphere injury? Damage to the right cerebellar hemisphere
Which has worst prognosis, decorticate or decerebrate posturing? Decerebrate
What are the two types of injury to the Red nucleus? 1. Decorticate posturing 2. Decerebrate posturing
Another way to refer to Decorticate posturing? Flexor posturing
How else is Decerebrate posturing referred as? Extensor posturing
Extensor posturing = Decerebrate postring
Flexor posturing = Decorticate posturing
What area of the brain is injured in decorticate/decerebrate posturing? Red nucleus
Description of Decorticate posturing? Lesion above red nucleus, presents with flexion of upper extremities and extension of lower extremities
Lesion at or below the red nucleus Decerebrate posturing
Decorticate posturing is due to lesion ---> Above red nucleus
Decerebrate posturing is due to lesion ---> At or below red nucleus
How is decerebrate posturing presented clinically? Extension of upper and lower extremities
How is Decorticate posturing presented clinically? Flexion of upper extremities and extension of lower extremities
If lower and upper extremities are extended, is it decerebrate or decorticate? Decerebrate
Upper extremities flexioned + Lower extremities extended; Decerebrate or Decorticate? Decorticate
Consequence of Cerebellar vermis Truncal ataxia and dysarthria
Description of Truncal ataxia due to Cerebellar vermis lesion: Wide-based, "drunken sailor" gait
Cerebellar vermis is _________________ located. Centrally
Central vermis lesioned ---> Affects central body
What action is associated with degeneration of cerebellar vermis? Chronic alcohol use
How long after initial event of an ischemic brain stroke, does the damage is irreversible? After 5 minutes of hypoxia
What brain areas are the most susceptible to ischemic brain stroke/disease? Hippocampus, neocortex, cerebellum, and watershed areas
What cells of the Cerebellum are known to be severely affected in an ischemic brain disease/stroke? Purkinje cells
What area of the brain is the MOST vulnerable to ischemic hypoxia? Hippocampus
What kind of imaging is done in an stroke prior to administration of tPA? Noncontrast CT to exclude hemorrhage
Why is a non-contrast CT performed before giving tPA to a stroke victim? To exclude hemorrhage
What is detected in a CT of a stroke patient? Ischemic changes in 6-24 hours
What is the purpose of Diffusion-weighted MRI in a person with a stroke? Detect ischemia within 3-30 minutes
What are the histologic features of a stroke within 12-24 from initial ischemic event? 1. Eosinophilic cytoplasm 2. Pyknotic nuclei (red neurons)
Time frame after initial ischemic event of stroke in which red neurons appear histologically? 12-24 hours
What are the "red neurons"? Neurons affected by ischemic brain event in the first 12-24 hours, that have pyknotic nuclei
Histologic features of an ischemic attack after 24-72 hours form initial event? Necrosis + neutrophils
How soon can neutrophils be seen in an ischemic brain event? 24-72 hours
The histological examination of a person with an recent ischemic brain event shows necrosis and neutrophils. What is the approximate timeframe? 24-72 hours from initial event
Time in which macrophages (microglia) apperats after initial ischemic brain event? 3-5 days
What histological features is seen around 3-5 days after initial ischemic brain event? Macrophages (microglia)
What cells are involved in Reactive gliosis? Astrocytes
What are the histological findings in a stroke victim after 1-2 weeks form initial ischemic event? 1. Reactive gliosis (astrocytes) 2. Vascular proliferation
Approximate time in which pathologist can see reactive gliosis in an ischemic brain attack victim? 1-2 weeks from initial event
Vascular proliferation is seen after __________________ from initial ischemic event. 1-2 weeks
A Glial scar is seen after _______________- from initial ischemic brain event. > 2 weeks
How long after initial ischemic attack, is a glial scar hisotoligally found? > 2 weeks
(+) Red neurons ---> Initial histological finding after a ischemic brain event, alongside with an eosinophilic cytoplasm.
What is the definition of an Ischemic stroke? Acute blockage of vessels leading to disruption of blood flow and subsequent ischemia, ultimately producing liquefactive necrosis
What type of necrosis is achieved by an ischemic stroke? Liquefactive necrosis
What kind of necrosis is found in a patient suffering of an ischemic stroke? Liquefactive necrosis
Acute blockage of brain blood vessels leading to a disruption of blood flow in the brain and causing ischemia. Ischemic stroke
What are the 3 types of ischemic strokes? 1. Thrombotic 2. Embolic 3. Hypoxic
Thrombotic ischemic stroke: Due to a clot forming directly at site of infaction, usually over an athrosclerotic plaque
What arterial body is commonly affected by development of an Thrombotic ischemic stroke? MCA
What is the most likely cause of an Embolic stroke? Embolus from another part of the body obstruct the brain vessel.
Which type of ischemic stroke is known to affect multiple vascular territories? Embolic
What are conditions that are associated with the development of an Embolic ischemic stroke? Atrial fibrillation, carotid artery stenosis, DVT with patent foramen ovale.
What is the most common cause for a Hypoxic ischemic stroke? Hypoperfusion or hypoxemia
Which is common type of ischemic stroke that develops during cardiovascular surgeries? Hypoxic
What areas are most affected or more commonly affected by a Hypoxic ischemic stroke? Watershed areas
When is tPA used in treating an ischemic stroke? - Within 3.-4.5 hours of onset - No hemorrhage/risk of hemorrhage
A patient with with an ischemic stroke that stated 5 hours ago, that has no signs of hemorrhage, should be treated with tPA? No, tPA administration should be only within 3-4.5 hours from onset.
What medications are known to reduce risk of developing an ischemic stroke? Aspirin and Clopidogrel
Brief, reversible episode of focal neurologic dysfunction without acute infarction, with majority resolving in < 15 minutes. Transient ischemic attack
The deficits seen in TIA are due to: Focal ischemia
Most TIAs are resolved (time): < 15 minutes
What is Neonatal Intraventricular hemorrhage? Bleeding into ventricles in neonates
Which conditions of neonates increase risk Neonatal intraventricular hemorrhage? Prematurity and Low-birth-weight infants
Where do neonatal intraventricular hemorrhage originate? Germinal matrix, a highly vascularized layer within the subventricular zone.
A highly vascularized layer within the subventricular zone. Germinal matrix
What is the cause of Neonatal Intraventricular hemorrhage? Due to reduced glial fiber support and impaired autoregulation of BP in premature infants.
What clinical signs of NIH? Altered level of consciousness, bulging fontanelle, hypotension, seizures, and coma.
Reduced glial fiber support and impaired autoregulation of BP in premature infants. Dx? Neonatal Intraventricular Hemorrhage (NIH)
List of causes or types of Intracranial hemorrhage: 1. Epidural hematoma 2. Subdural hematoma 3 .Subarachnoid hemorrhage 4. Intraparenchymal hemorrhage
What is the MCC of Epidural hematoma? Rupture of middle meningeal artery, often secondary to skull fracture involving the pterion.
Common branch of the Maxillary artery involved in Epidural hematoma? Middle Meningeal artery
What is the Pterion? Thinnest areal of the lateral skull
A blow to the lateral side of the skull, rupturing the MMA. Dx? Epidural hematoma
Which type f intracranial hematoma is seen with an "lucid interval"? Epidural hematoma
Scalp hematoma and rapid intracranial expansion under systemic arterial pressure causing transtentorial herniation, and CN III palsy? Epidural hematoma
Which type of intracranial hemorrhage is associated with development of Transtentorial herniation and CN III palsy? Epidural hematoma
What is shown in CT on an Epidural hematoma? Biconvex (lentiform), hyperdense blood collection not crossing suture lines
CT --> Hyperdense blood collection not crossing suture lines. Dx? Epidural hematoma
CT--> Biconvex (lentiform) blood collection Epidural hematoma
What is the MCC of Subdural hematoma? Rupture of bridging veins
What condition is due to the rupture of bridging veins? Subdural hematoma
What are acute causes of a Subdural hematoma? Traumatic, high-energy impact --> hyperdense of CT
What are the chronic causes of a Subdural hematoma? Mild trauma, cerebral atrophy, elderly, alcoholism --> hypodense on CT
If the CT of an Subdural hematoma shows a hypodense image is it chronic or acute cause? Chronic
What infant condition is associated with developing Subdural hematoma? Shaken babies
A baby abused by shaken, may develop what type of intracranial hematoma? Subdural hematoma
What are predisposing factors of Subdural hematoma? Brain atrophy and trauma
Crescent-shaped hemorrhage that crosses suture lines on CT. Dx? Subdural hematoma
Lentiform or Crescent-shaped on CT of Subdural hematoma. Crescent
Lentiform or Crescent-shaped on CT of Epidural hematoma. Lentiform
What is a Subarachnoid hemorrhage? Bleeding due to trauma, or rupture of an aneurysm or AVM.
What is the intracranial hemorrhage due to rupture of an aneurysm? Subarachnoid hemorrhage
Patients complain of "worst headache of my life". Dx? Subarachnoid hemorrhage
Bloody or yellow spinal tap. Dx? Subarachnoid hemorrhage
What condition is seen with a xanthochromic spinal tap? Subarachnoid hemorrhage
What is a serious complication of Subarachnoid hemorrhage? - Vasospasm due to blood breakdown, or - Rebleed 3-10 days after hemorrhage
What medication or drug is used to prevent vasospasm due to Subarachnoid hemorrhage? Nimodipine
Why is Nimodipine used in Subarachnoid hemorrhage? It used to prevent/reduce vasospasm due to SAH.
What are conditions that have increased risk of developing in a patient with SAH? Communicating and/or obstructive hydrocephalus
What is the MCC of intraparenchymal hemorrhage? Systemic hypertension
What are conditions associated with developing an intraparenchymal hemorrhage? Amyloid angiopathy, vasculitis, neoplasm.
What are the most common causes of hypertensive hemorrhages in the brain? Charcot-Bouchard microaneurysm
Where do most Charcot-Bouchard microaneurysm occur? Putamen of basal ganglia
What are the vessels most likely affected in Charcot-Bouchard microaneurysms? Lenticulostriate vessels
Other than the Putamen of basal ganglia, where else is common to Charcot-Bouchard aneurysms? Thalamus, pons, and cerebellum,
Intraparenchymal hemorrhage due to amyloid angiopathy presents with: Recurrent lobar hemorrhagic stroke in elderly
If a stroke affects the Middle Cerebral artery, which area(s) of the brain are most affected? 1. Motor and sensory cortices-- upper limb and face 2. Temporal lobe (Wernicke area); 3. Frontal lobe (Broca area)
Which arterial body is most likely affected if the patient presents with contralateral paralysis and sensory loss of face and upper limb? MCA
What ophthalmological deficit is associated with Wernicke aphasia? Right superior quadrant visual field defect due to temporal lobe involvement
Which anterior brain circulation artery if suffers a stroke affects the Wernicke and Broca areas? MCA
What area of lesion in a stroke affecting the Anterior cerebral artery? Motor and sensory cortices --- lower limb
Arterial body affected in a stroke that presents with contralateral paralysis and sensory loss of the lower limb and with urinary incontine? ACA
ACA occlusion/stroke affects the ----> Contralateral legs
MCA occlusion/stroke affects the ---> Contralateral face and arms
What are the clinical signs presented if a patient suffers a right ACA stroke? Left motor paralysis and sensory loss of lower extremity.
A patient presents with left sided face and left side arm numbness and difficulty moving it. What arterial body most lifkely has been affecred by a stroke? MCA
Areas of lesion of a Lenticulostriate artery stroke? Striatum and internal capsule
Areas affected: Striatum and Internal capsule. What is the most likely stroke? Lenticulostriate artery stroke
What are the symptoms of Lenticulostriate artery stroke? 1. Contralateral paralysis 2. Absence of cortical signs
What is a common location for Lacunar infarcts due to hyaline arteriosclerosis secondary to uncontrolled hypertension? Lenticulostriate artery
What is the reason of Lacunar infarcts? Hyaline arteriosclerosis secondary to uncontrolled hypertension
How would the absence of cortical signs present as? Neglect, aphasia, and visual field loss
What arterial bodies compose the anterior circulation of the brain? 1. MCA 2. ACA 3. Lenticulostriate artery
Main stroke related posterior brain circulation arteries: 1. Anterior spinal artery 2. Posterior inferior cerebellar artery (PICA) 3. Anterior Inferior cerebellar artery (AICA)
What structures are affected by Anterior spinal artery stroke/occlusion? 1. Lateral corticospinal tract 2. Medial lemniscus 3. Caudal medulla - hypoglossal nerve
Clinical features of Anterior spinal artery stroke affecting the Lateral corticospinal tract: Contralateral paralysis -- Upper and Lower limbs
How is a ASA stroke affecting the lateral corticospinal tract different to a MCA or ACA stroke? ASA stroke to the lateral corticospinal tract, affects both legs and arms of the contralateral side, while ACA affects contralateral leg, and MCA contralateral face and arm.
What area affected in a ASA stroke causes a decrease in contralateral proprioception? Medial lemniscus
What is the symptom that indicated medial lemniscus injury in an ASA stroke? Decrease contralateral proprioception
What is the consequence of ASA stroke affecting the Cauda medulla (Hypoglossal nerve)? Ipsilateral hypoglossal dysfunction with causes tongue deviation ipsilateral
Ipsilateral or Contralateral. Tongue deviation in ASA stroke. Ipsilateral
Which cranial nerve is involved with an ASA stroke? Hypoglossal nerve
What is the common syndrome associated with Anterior spinal artery stroke? Medial Medullary syndrome
What is the cause of Medial medullary syndrome? Infarct of Paramedian branches of ASA and/or vertebral arteries
Infarct to the branches of the ASA and/or vertebral arteries. Dx? Medial Medullary syndrome
Associated affected artery in Medial medullary syndrome? Anterior Spinal artery
Associated syndrome of due to occlusion/stroke of the PICA? Lateral medullary syndrome
What is another way to refer to Lateral medullary syndrome? Wallenberg syndrome
What are the 5 main areas of lesion in occlusion/stroke of the Posterior inferior cerebellar artery (PICA)? 1. Lateral medulla: Nucleus ambiguus (IX, X, XI) 2. Vestibular nuclei 3. Lateral spinothalamic tract, spinal trigeminal nucleus 4. Sympathetic fibers 5. Inferior cerebellar peduncle
What is the clinical result of PICA occlusion affecting the Lateral medulla? Dysphagia, hoarseness, decreased gag reflex, and hiccups
What area is affected in PICA occlusion that lead to symptoms of dysphagia, decreased gag reflex, hoarseness, and hiccups? Latear medulla (nucleus ambiguus CN IX, X, XI)
Affecting the vestibular nucleus in PICA occlusion is presented with: Vomiting, vertigo, and nystagmus
What are is there result of damage to the Lateral spinothalamic tract and spinal trigeminal nucleus in PICA stroke? Decreased pain and temperature sensation from contralateral body, and ipsilateral face
What part of the face losses sensation in PICA occlusion? Ipsilateral
What are the clinical effects of affects of the inferior cerebellar peduncle, due to PICA occlusion? Ipsilateral ataxia and dysmetria
What is the Lateral medullary (Wallenberg) syndrome? Condition due to PICA stroke/occlusion.
What are the main clinical effects Wallenberg syndrome? Nucleus ambiguus effects such as dysphagia, hoarseness, decreased gag reflex, and hiccups.
What is affected in PICA occlusion that leads to development of Ipsilateral Horner syndrome? Sympathetic fibers
What areas are affected by AICA stroke/ occlusion? 1. Lateral pons: Facial nucleus 2. Vestibular nuclei 3. Spinothalamic tract, spinal trigeminal nucleus 4. Sympathetic fibers 5. Middle and inferior cerebellar peduncles 6. Labyrinthine artery
What artery is affected in AICA occlusion that leads to deafness and vertigo? Labyrinthine artery
What is the syndrome associated with AICA occlusion or stroke? Lateral pontine syndrome
Lateral pontine syndrome. Associated with what cerebral artery? AICA
Lateral medullary (Wallenberg) syndrome. Associated with ____________ occlusion. PICA
Medial medullary syndrome. Associated with deficits in which posterior circulation cerebral artery? Anterior spinal artery (ASA)
What deficits give Lateral Pontine syndrome its main symptoms? Facial nucleus effects such as: Paralysis of face, decreased lacrimation, salivation , and taste from anterior 2/3 tongue.
What are the clinical effects of defects in the Facial nucleus? - Paralysis of face - Decreased lacrimation, salivation, - Decreased taste from anterior 2/3 of tongue
Which syndrome is associated with the development of a "facial droop" and decreased lacrimation, salivation, and taste of anterior 2/3 of tongue? Lateral pontine syndrome
What are the symptoms due to deficits to the Labyrinthine artery in AICA occlusion? Ipsilateral sensorineural deafness and vertigo
What are the effects of damage to the Spinothalamic tract, and spinal trigeminal nucleus? Decreased pain and temperature sensation from contralateral body, and ipsilateral face
What areas are affected by occlusion of the Basilar artery? 1. Pons, medulla, lower midbrain 2. Corticospinal and corticobulbar tracts 3. Ocular cranial nerve nuclei, paramedian pontine reticular formation
What is the associated condition with a Basilar artery stroke? Locked-in syndrome
Locked-in syndrome is due to occlusion/stroke to which artery? Basilar artery
What are the significant symptoms in Locked-In syndrome? 1. Preserved consciousness 2. Quadriplegia 3. Loss of voluntary facial, mouth, and tongue movements 4. Loss of horizontal, but not vertical, eye movements
What area is lesioned in Locked in syndrome, that causes the movement defectis? Corticospinal and corticobulbar tracts
Which tracts are affected in Locked in syndrome? Corticospinal and corticobulbar tracts
Patient in bed, unable to speak, move, or make facial grimaces. Communicates only by vertical eye movements, and is conscious of surrounding. Dx? Locked-in syndrome
Locked-In syndrome associated artery? Basilar artery
If the PCA is occluded or suffers a stroke, what area of the brain is lesioned? Occipital lobe
If the occipital lobe is damaged due to ischemia, which is the most likely obstructed/occluded arterial body? PCA
What are the common symptoms of PCA occlusion? 1. Contralateral hemianopia with macular sparing 2. Alexia without agraphia
What is "Alexia without agraphia"? Dramatic disorder of higher visual function in which patients can still write but are unable to read.
What artery is at suspicion of occlusion if a patient can write, but is unable to read? PCA
Higher visual function in which patients can still write but can't read. Alexia without agraphia
What Cerebral Posterior circulation artery, if obstructed or suffer an stroke, causes contralateral hemianopia with macular sparing? PCA
What is Central Post-stroke pain syndrome? Neuropathic pain due to thalamic lesions
What it the initial course of Central post-stroke pain syndrome? Paresthesias followed in weeks to moth by allodynia and dysesthesia on the contralateral side.
What is allodynia? It is when a patient that experiences ordinarly painless stimuli causes him/her pain.
Extreme, exaggerated, not fictional but intense sensation of pain, in stimuli that commonly is painless. Allodynia
Contralateral or Ipsilateral. The dysesthesia seen in Central post-stroke pain syndrome. Contralateral
What causes Diffuse axonal injury? Traumatic shearing forces furin rapid acceleration and/or deceleration of the brain.
What is a common example of something that causes diffuse axonal injury? Motor Vehicle accident (MVA)
What are the severe results of diffuse axonal injury? Coma or persistent vegetative state
Which condition is known to show multiple lesions (punctate hemorrhages) involving the white matter tracts? Diffuse axonal injury
What is the name of CN I? Olfactory
What is the function of CN I? Smell
Smell is sensed by which cranial nerve? Olfactory
Which is the only cranial nerve without Thalamic relax to cortex? Olfactory
What is a unique CN characteristic? Only cranial nerve without thalamic relay to cortex
Sensory or Motor. Olfactory cranial nerve? Sensory
CN I is an sensory or motor cranial nerve type? Sensory
Name of CN II Optic
What is the function of CN II? Sight
Which cranial nerve's function is sight? Optic
Sensory or Motor. Optic cranial nerve? Sensory
Is CN II an sensory or motor type cranial nerve? Sensory
What number is the Oculomotor nerve? III
Name of CN III Oculomotor
List of functions of the CN III: 1. Eye movement 2. Pupillary constriction 3. Accomodation 4. Eyelid opening
Which eye movement (ocular) muscles are innervated by CN III? SR, IR, MR, and IO
What are features of the sphincter pupillae? 1. Edinger-Westphal nucleus 2. Muscarinic receptors
What type of receptors are associated with the sphincter pupillae? Muscarinic receptors
Which muscle makes eyelid opening possible? Levator palpebrae
Sensory, Motor, or Both. Oculomotor nerve? Motor
What type of nerve is the CN III? Motor
What is the name of CN IV? Trochlear
What number is the Trochlear nerve? IV
What is the function of CN IV? Eye movement
Eye movement by the Trochlear nerve is done by the innervation of which ocular muscle? SO
Which is the only eye muscle innervated by the CN IV? SO
Sensory, Motor, or Both. CN IV? Motor
What is the name of CN V? Trigeminal
What are the functions of the Trigeminal nerve? 1. Mastication 2. Facial sensation 3. Somatosensation from anterior 2/3 of tongue 4. Dampening of loud noises
What are the divisions of the CN V that provide Facial sensation? Ophthalmic, Maxillary, and Mandibular
To what part of the tongue does the Trigeminal nerve provide somatosensation? Anterior 2/3 of tongue
What muscle is innervated by the CN V that dampens loud noises? Tensor tympani
The Tensor tympani is innervated by which cranial nerve? Trigeminal
Sensory, Motor, or Both. Trigeminal nerve? Both
Which cranial nerves are both, motor and sensory? Trigeminal (V), Facial (VII), Glossopharyngeal (IX), and Vagus (X)
Name of CN VI? Abducens
The Abducens cranial nerve is what number? VI
What is the involved action of CN VI? Eye movement
Which ocular muscle is innervated by CN VI? LR
The lateral rectus is innervated by the ________________ nerve. Abducens
Sensory or Motor. Abducens nerve? Motor
What is the name for CN VII? Facial
List of functions of CN VII: - Facial movement - Taste from anterior 2/3 of tongue - Lacrimation - Salivation - Eye closing - Auditory volume modulation
Which glands innervated by CN II cause salivation? Submandibular and Sublingual glands
What muscle causes eye closing? Orbicularis oculi
The Orbicularis oculi is innervated by which CN? Facial
The Chorda tympani is innervated by the ______________ nerve. Facial
Auditory muscle innervated by the __________ nerve. Facial
What is the function of the Stapedius muscle? Auditory volume modulation
Sensory, Motor, or Both. CN VII? Both
What type of nerve is the Facial cranial nerve, sensory or motor? Both
What is the name for CN VIII? Vestibulocochlear
What Roman number is given to the Vestibulocochlear nerve? VIII
What are the associated functions of the Vestibulocochlear nerve? Hearing and balance
Damage to the CN VIII may cause deficits in: Hearing and balance
A person with a clear loss of balance and hard of hearing, might suffered from either compression or damage to which cranial nerve? Vestibulocochlear
What type of nerve is CN VIII, sensory or motor? Sensory
Sensory or motor. Vestibulocochlear nerve? Sensory
What is the name for CN IX? Glossopharyngeal
What is the roman numeral designated for the Glossopharyngeal nerve? IX
What are some of the associated functions of CN IX? 1. Taste and sensation from posterior 1/3 of tongue, 2. Swallowing 3. Salivation 4. Monitoring carotid body and sinus chemo- and baroreceptors, 5. Elevation of pharynx/larynx
Which part of the tongue is innervated by the Glossopharyngeal nerve? Posterior 1/3
CN IX innervation of the posterior 1/3 of tongue provides: Taste and sensation
CN associated with Carotid body and sinus chemo- and baroreceptor monitoring? Glossopharyngeal
Which chemo- and baroreceptors are monitored by the CN IX? Carotid body and sinus
Sensory, Motor, or Both. Cranial nerve 9? Both
What muscle is innervated by the Glossopharyngeal nerve that elevate pharynx/ larynx? Stylopharyngeus
The Stylopharyngeus is innervated by the ______________ nerve. Glossopharyngeal
Vagus nerve roman numeral X
What is the name for CN X? Vagus
List of functions for CN X? - Taste from supraglottic region - Swallowing - Soft palate elevation - Midline uvula - Talking - Cough reflex - Parasympathetics to thoracoabdominal viscera - Monitoring aortic arch chemo- and baroreceptors
Which chemo- and baroreceptors are monitored by the Vagus nerve? Aortic arch
Deficient response of aortic arch chemoreceptors and baroreceptors may be due to damage to which cranial nerve? Vagus
Which reflex is associated with proper Vagus nerve functioning? Cough reflex
(-) Cough reflex. Dx? Damage/injury to CN X
Which CN is involved in Soft palate elevation? Vagus
CN that provides taste to the Supraglottic region? Vagus
Sensory, Motor, or Both. Vagus nerve? Both
Motor and sensory CN that is involved in swallowing, talking and midline uvula location? Vagus
Name of the CN XI? Accessory
What is the Roman numeral given to the Accessory nerve? XI
What are the functions involved with the Accessory nerve? Head turning, shoulder shrugging (SMC, trapezius)
Which shoulder/neck muscles are innervated by CN XI? Sternocleidomastoid and Trapezius
What type of nerve is CN XI, sensory or motor? Motor
A person with difficulty shrugging the shoulder, most likely indicates injury to which cranial nerve? Accessory
Name of CN XII: Hypoglossal
What is the function associated with CN XII? Tongue movement
Sensory or Motor. Hypoglossal nerve? Motor
What action would be deficient or abnormal in case of injury to Hypoglossal cranial nerve? Tongue movement
Which medulla nucleus coordinates the vomiting center? Nucleus tractus solitarius (NTS) in the medulla
Which areas or zones send to NTS in medulla? 1. Chemoreceptor trigger zone (CTZ) 2. GI tract via vagus nerve 3. Vestibular system 4. CNS
Where is the CTZ located? Within area postrema in 4th ventricle
CTZ and adjacent vomiting center nuclei receive input form 5 major receptos: 1. Muscarinic (M1), 2. Dopamine (D2), 3. Histamine (H3), 4. Serotonin (5-HT), 5. Neurokinin (NK-1)
What muscarinic receptor is associated with the CTZ and vomiting centers nuclei? M1
Which receptor antagonists are used to treat chemotherapy-induced vomit? 5-HT3, D2, and NK-1 receptors
Which two of the five antagonists are sued to motion sickness and hyperemesis gravidarum? M1 and H1 receptors
M1 and H1 antagonists are used to treat? Motion sickness and hyperemesis gravidarum
Serotonin, D2, and NK-1 antagonists are used to treat: Chemotherapy-induced vomiting
What important physiologic center is located in the NTS in the medulla? Vomiting center
The sleep cycle is regulated by the _______________ rhythm. Circadian rhythm
The Suprachiasmatic nucleus of hypothalamus ---> Drives the sleep cycle with regulates the circadian rhythm.
What is controlled by the Circadian rhythm? Nocturnal release of ACTH, prolactin, melatonin, norepinephrine
What regulates Suprachiasmatic nucleus (SCN)? Environment (light)
Which gland releases melatonin? Pineal gland
SCN --(+)---> NE release ==> Pineal gland which releases melatonin
What are the two stages of Sleep physiology? Rapid-eye movement (REM) and non-REM
What substances and drug types are associated with a decrease in REM sleep and delta wave sleep? Alcohol, benzodiazepines, and barbiturates
What happens to REM sleep with increase norepinephrine? Decrease REM sleep
A patient with decreased REM sleep and a decreased delta wave is often associated to consumption of : Alcohol, benzodiazepines, and barbiturates
Which type of medications are proven to help for night terrors? Benzodiazepines
Which sleep disorder conditions are treated with Benzodiazepines? Night terrors and sleepwalking
What is the MOA of benzodiazepines ahta aid in treating Night terrors and sleepwalking? Decreased N3 and REM sleep
What are the main sleep stages? 1. Awake (eyes open/closed) 2. Non-REM sleep (N1, N2, and N3) 3. REM sleep
Which is the description for the awake with eyes open sleep stage? Aleer, active mental concentrations
What is the associated EEG waveform of the Awake with eyes open of the sleep stages? Beta waves
Which sleep stages have Beta waves in the EEG? 1. Awake (eyes open) 2. REM sleep
Alpha waves of EEG are associated with which sleep stage? Awake (eyes closed)
What are the subdivisions of Non-REM sleep? Stage N1, Stage N2, and Stage N3
Which non-REM sleep is the largest or with the largest percentage? Stage N2
What is the description of Stage N1 of sleep? Light sleep
Which stage of sleep is described as "light sleep"? Stage N1
What are the associated EEG waveforms of Non-REM Stage N1? Theta waves
(+) Theta waves on EEG. Stage N1
Which sleep stage accounts for approximately 75% of all sleep cycle? Non-REM sleep
Description of N2 stage of Non-REM sleep Deeper sleep that Stage N1; bruxism occurs
Which sleep stage is associated with Bruxism? Stage N2
What is Bruxism? Teeth grinding
EEG waveform of Non-REM stage N2 sleep Sleep spindles and K complexes
(+) Sleep spindles and K complexes on EEG Non-REM sleep stage N2
Which stage has the deepest non-REM sleep? Stage N3
Which EEG waveform has the lowest frequency and highest amplitude? Delta wave
Associated waveform of Stage N3 of sleep? Delta wave
Slow-wave sleep? Stage N3
What is the description of non-REM sleep Stage N3? Deepest non-REM sleep; associated with sleepwalking, night terrors, and bedwetting
Which conditions are associated with non-REM Stage N3 sleep? 1. Sleepwalking 2. Night terrors 3. Bedwetting
Loss of motor tone, increased brain oxygen use, and increase variable pulse and BP, and elevated ACh Description of REM sleep
What physiological conditions are associated REM sleep? - Dreaming - Nightmares - Penile/clitoral tumensce
Which sleep stage may present with penile erection? REM sleep
Which mood disorder is associated with increased REM sleep but decreased REM latency? Depression
What accounts for the extraocular movements in REM sleep? Activity of PPRF
What is the PPRF? Paramedian Pontine Reticular formation/ conjugate gaze center.
How often does REM sleep occur? Every 90 minutes, and duration increases through the night
REM sleep associated EEG waves Beta waves
Dreams happen during __________________ sleep. REM
Major relay for all ascending sensory information except olfaction Thalamus
Which are the nuclei of the Thalamus? 1. Ventral Postero-Lateral nucleus 2. Ventral Postero-Medial nucleus 3. Lateral geniculate nucleus 4. Medial geniculate nucleus 5. Ventral lateral nucleus
The VPL and VPM nucleus are part of the _________________. Thalamus
Which ascending sensory information does not relay in the Thalamus? Olfactory
What is the input of the Ventral Posterolateral nucleus of the Thalamus? Spinothalamic and dorsal columns/ medial lemniscus
The Spinothalamic and dorsal columns and medial lemniscus is the input of the: Ventral Posterolateral nucleus of the Thalamus
What is sensed by the VPL nucleus of the Thalamus? Vibration, Pain, Pressure, Proprioception, Light touch, and temperature.
What is the destination of of the sensory information coming from the VPL nucleus of thalamus? Primary somatosensory cortex
Which thalamic nucleus have as destination the Primary somatosensory cortex? VPL and VPM nuclei
What is the input of the Ventral posterolateral nucleus of the thalamus? Trigeminal and gustatory pathway
What are the sensation of the VPM nuclei of the thalamus? Face sensation and taste
Which hypothalamic nucleus is damaged if there is decreased sensation of the face and taste? Ventral Postero-Medial nucleus
Input Trigeminal and gustatory pathway. Thalamic nucleus? Ventral Postero-Medial nucleus
What is the input of the Thalamic lateral geniculate nucleus? CN II, Optic chiasm, and Optic tract
Associated thalamic nucleus of the CN II, optic chiasm, and optic tract? Lateral geniculate nucleus
What is sensed by LGN of the thalamus? Vision
Vision associated ________ _________ nucleus of the thalamus Lateral geniculate nucleus
What is the destination of the Lateral geniculate nucleus sensory input? Calcarine sulcus
The Calcarine sulcus receives sensory information of which Thalamic nucleus? Lateral geniculate nucleus
Medial geniculate nucleus receives input from the: Superior olive and inferior colliculus of tectum
What senses the Medial geniculate nucleus sensory fibers? Hearing
Hearing is sense by the ____________ nucleus of the thalamus Medial geniculate nucleus
What is the destination of the sensor pathways that relay by the Medial geniculate nucleus? Auditory cortex of temporal lobe
Associated destination of the MGN of the thalamus? Auditory cortex of temporal lobe
The ventral lateral nucleus has input of : Basal ganglia and cerebellum
The Ventral lateral nucleus senses ________________ functions. Motor
What is the final destination of the sensory information relayed in the thalamus ventral lateral nucleus? Motor cortex
What is the Limbic system? Collection of neural structures involved in emotion, long-term memory, olfaction, behavior modulation, and ANS function
What does the Limbic system consists of? Hippocampus, Amygdala, Mammillary bodes, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex.
What neurological structure or system is made up of the hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex? Limbic system
The limbic system is responsible for: 1. Feeding, 2. Fleeing, 3. Fighting, 4, Feeling, 5. Sex (fucking)
What are the famous 5 F's of the limbic system? Feeding, fleeing, fighting, feeling, and Fukcing (sex)
List of Dopaminergic pathways: 1. Mesocortical 2. Mesolimbic 3. Nigrostriatal 4. Tuberoinfundibular
What are the "negative"symptoms associated with Dopamine? Anergia, apathy, and lack of spontaneity
A decreased in which dopaminergic pathway lead to development of negative symptoms? Mesocortical
Decreased activity in the mesocortical dopaminergic pathway --> "negative" symptoms
Antipsychotic drugs have a limited effect on which dopaminergic pathway? Mesocortical
Increased activity in the Mesolimbic dopaminergic pathway lead to: Development of "positive" symptoms
What are the positive symptoms associated with Dopamine? Delusions and hallucinations
Which dopaminergic pathway represents the primary target of the antipsychotic drugs? Mesolimbic
Inhibition of the mesolimbic dopaminergic pathway lead to: Decrease positive symptoms in Schizophrenia
Dopaminergic pathways are altered by which drugs? Antipsychotics
Which two features alter the Dopaminergic pathways? Drugs (antipsychotics) and movement disorders (Parkinson disease).
What is the major dopaminergic pathway in the brain? Nigrostriatal
Decreased activity of this dopaminergic pathway leads to the development of Extrapyramidal symptoms? Nigrostriatal
What are the Extrapyramidal symptoms? Dystonia, Akathisia, parkinsonism, and tardive dyskinesia
Which Dopaminergic pathway is most affected by drugs and movement disorders? Nigrostriatal
Disorder that leads to an undeveloped or nonfunctional Nigrostriatal dopaminergic pathway will present clinically be the development of: Extrapyramidal symptoms
Which Dopaminergic pathway is associated with libido, sexual function, galactorrhea and gynecomastia in men? Tuberoinfundibular
A decrease activity in the Dopaminergic Tuberoinfundibular pathway leads to a ____________________ in prolactin. Increase
Hyperprolactinemia may be due to damage to which dopaminergic pathway? Tuberoinfundibular
What are the results of decrease activity in the Tuberoinfundibular pathway? Hyperprolactinemia which leads to decreased libido, sexual dysfunction, galactorrhea, and gynecomastia in men.
Functions of the Cerebellum: 1. Modulates movement 2. Aids in coordination and balance
What are the 2 inputs of the Cerebellum? 1. Contralateral cortex via middle cerebellar peduncle 2. Ipsilateral cerebellar peduncle from spinal cord
What i the contralateral input of the cerebellum? Cortix via middle cerebellar peduncle
What is the is ipsilateral input of the cerebellum? Proprioceptive information via inferior cerebellar peduncle form the spinal cord
Output of the Cerebellar cortex: Purkinje cells --> deep nuclei of cerebellum ----> contralateral cortex via superior cerebellar peduncle
Which cerebellar peduncle is used output information from the cerebellar cortex? Superior cerebellar peduncle
What cells are involved in the output of information form the cerebellar cortex? Purkinje cells
Cerebellar Purkinje cells are always _________________. Inhibitory
True or False. Cerebellar Purkinje fibres are stimulatory and inhibitory. False; Always and only inhibitory
What is the deep nuclei out of the cerebellum? Dentate, Embolofrm, Globose, and Fatigal
Direction of output for the cerebellum deep nuclei output? Lateral to medial
What is affected by LATERAL lesions to the cerebellum? Voluntary movement of the extremities
What is a common symptom of a cerebellum lateral injury? Propensity to fall toward ipsilateral side
A person falls has a tendency to fall to the right side, and has difficulty moving arms on command. Dx? Right side cerebellum injury
What are the medial structures of the Cerebellum? Vermis, fastigial nuclei, and floculonodular lobe
What clinical features of a medial cerebellar lesion? 1. Truncal ataxia 2. Nystagmus 3. Head tilting
Lateral of Medial lesions to the cerebellum cause bilateral motor deficits affecting axial and proximal limb musculature? Medial
What structures, medial or lateral cerebellum, in order to show wide-based cerebellar gait? Medial
Modulates movement and aids in coordination and balance. Cerebellum
The contralateral cortex input of the cerebellum is via the: Middle cerebellar peduncle
Function of middle peduncle of cerebellum Provide input to the contralateral cortex of the cerebellum
Function of the Inferior cerebellar peduncle? Provide input concerning ipsilateral proprioception
Which structure is important in voluntary movements and making postural adjustments? Basal ganglia
What type of input is received by the Basal ganglia? Cortical input
Provides negative feedback to cortex to modulate movement. Basal ganglia
What type of feedback is provided by the Basal ganglia? Negative feedback to cortex to modulate movement
Putamen + Caudate = Striatum
What composes the Striatum? Putamen and Caudate
What provides the motor part of the Striatum? Putamen
Which component of the Striatum provides the cognitive features? Caudate
Lentiform = Putamen + globus pallidus
Putamen and the Globus pallidus, compose the ________________, of the basal ganglia. Lentiform
If the putamen is added to the caudate, it then makes up the _______________. Striatum
Lentiform = Putamen + _____________________. Globus pallidus
Which, D1 or D2, is the direct pathway in the basal ganglia? D1
Which is the inhibitory pathway of the basal ganglia, D1 or D2? D2
What is another way to refer to the Direct pathway of the Basal ganglia? Excitatory
What is another form to refer to the Indirect pathway of the Basal ganglia? Inhibitory
SNc input stimulate the striatum, stimulating the release of GABA, which inhibits GABA release from the GPi, disinhibiting the thalamus via the GPi. Direct (excitatory) pathway of the basal ganglia
The direct pathway of the Basal ganglia, stimulates the striatum which causes ---> Striatal release of GABA
What is the overall result of the direct pathway of the basal ganglia? Increase motion
Which pathway of the basal ganglia is designed to decrease motion? Indirect (inhibitory) pathway
Which structure stimulates the striatum in both, the indirect and direct pathways of the basal ganglia? SNc (Substantia nigra)
How does dopamine causes increased motion by acting on the Basal ganglia pathways? Binding to D1 to stimulate the excitatory pathway, and D2, by inhibiting the inhibitory pathway
Inhibition of the inhibitory pathway leads to increased movement Dopamine binding to D2 receptor in the Basal ganglia
Which areas of the brain are located in the Frontal lobe? - Primary motor - Premotor cortex - Frontal eye field - Prefrontal association area - Broca area
The Sylvian fissure borders with brain lobes? Frontal lobe and Temporal lobe
On which brain lobe is the Wernicke area located? Temporal lobe
Which important area or brain region is located at the Occipital lobe of the brain? Primary visual cortex
Which lobe would be affected if there is traumatic damage to the Primary visual cortex? Occipital lobe
On which brain lobe is the Primary auditory cortex located? Temporal lobe
Which are the gyri and areas associated with the Parietal lobe? - Primary somatosensory gyrus - Somatosensory association cortex
What association area is located in the anterior part of the Temporal lobe of the brain? Limbic association area
Which areas and cortex are located in the Temporal lobe of the brain? Limbic association area, Wernicke area, and Primary auditory cortex.
What is the "Homunculus"? Topographic representation of motor ans sensory areas in the cerebral cortex
Which is the Homunculus presented with a "distorted appearance"? Due to certain body regios being more richly innervated and thus having increased cortical representation
Brain perfusion relies strongly on ____________________. Autoregulation
Cerebral perfusion is primarily driven by: P CO2
At what point is PO2 also a modulator of cerebral perfusion? Severe hypoxia
What is the pressure gradient by which cerebral perfusion is based on? Between mean arterial pressure (MAP) and ICP
A decrease on BP has what effect on cerebral perfusion pressure? Decreased cerebral perfusion pressure
A decrease or increase on ICP will result in a decrease on CPP (cerebral perfusion pressure)? Increase in ICP
Therapeutic hyperventilation: 1. Decreases Partial CO2 (PCO2), which leads to ---> 2. Vasoconstriction, ---> 3. Decrease in cerebral blood flow which causes: 4. Decreased ICP
In order to achieve physiological decrease of ICP, the patient can be instructed to modified his/her breathing in what way? Hyperventilate
What does the hyperventilation causes to the levels of PCO2 in the brain vasculature? Decreases PCO2 with causes vasoconstriction
What is a possible reason to apply therapeutic hyperventilation? Treat acute cerebral edema unresponsive to other interventions
CPP = (mathematical equation) MAP - ICP
What is the difference of MAP -ICP? Cerebral perfusion pressure
What does a CPP = 0, indicate? No cerebral perfusion leading to brain death
When can hypoxemia cause an increase in CPP? Only if P O2 is < 50 mm Hg
CPP is directly proportional to PCO2 until? PCO2 is > 90 mm Hg.
Which cerebral artery supplies the anteromedial surface of the cortical brain? Anterior cerebral artery
What is irrigated by the Middle cerebral artery? Lateral surface of the cortical brain
Which cortical surfaces of the brain are supplied by the Posterior cerebral artery? Posterior and Inferior surfaces
Watershed areas of the brain: 1. Between the ACA and MCA 2. Between the PCA and MCA 3. Between the Superficial and deep vascular territories of the MCA
What condition affects the brain watershed areas? Severe hypotension
What are the symptoms of damage of watershed areas by severe hypotension? - Proximal upper and lower extremity weakness - Higher order visual dysfunction
What are the expected clinical signs of watershed zone damage if the internal border zone was damaged? Proximal upper and lower extremity weakness
What is clinically seen in damgate to the watershed area formed between the PCA and MCA border zone? Higher order visual dysfunction
What is the Circle of Willis? System of anastomoses between anterior and posterior blood supplies to brain.
Which arteries form the anterior circulation of the brain? ACA, ICA, and MCA
PCA, Basilar artery, and the Vertebral artery make up the _______________ circulation of the brain. Posterior
The Lenticulostriate arteries branch off the ___________. MCA
What are the Dural venous sinuses? Large venous channel that run through the periosteal and meningeal layer of the dura mater
What is the function of the dural venous sinuses? 1. Drain blood from cerebral veins and, 2. Receive CSF from arachnoid granulations
Into which important venous body do dural venous sinuses drain? Internal jugular vein
The internal jugular vein receives drainage from: The dural venous sinuses
What is the main clinical presentation of a patient with a Venous sinus thrombosis? Increased ICP
What are the common clinical signs of increased ICP? Headache, seizures, papilledema, and focal neurological defects
Serious complication of venous sinus thrombosis? Venous hemorrhage
What are the associated hypercoagulable states that increase risk for venous sinus thrombosis development? Pregnancy, OCP use, and factor V Leiden
Which is the main location of CSF return via the arachnoid granulations? Superior sagittal sinus
Anatomically, wheres is the Cavernous sinus located with respect to the Sphenoparietal sinus? Posteriorly
Which dural venous sinus is the the most superior? Superior sagittal sinus
On which lobe of the brain is the Confluence of the sinuses located? Occipital lobe
What are the ventricles that make up the CNS ventricular system? Lateral ventricles, Third ventricle, and the Fourth ventricle
In the ventricular system, arrange from the most superior to the inferior the ventricles involved: Lateral ventricles, Third Ventricle Fourth Ventricle
What structure is between the 3rd and 4th Ventricles? Cerebral aqueduct of Sylvius
Which structure connects the 3rd ventricle with the Lateral ventricle? Interventricular foramina of Monro
Which foramina connect or serve as conducts between the 4th Ventricle and the Subarachnoid space? 1. Foramina of Luschka 2. Foramen of Magendie
Which is the medial foramina that allows 4th ventricle CSF to reach the subarachnoid space? Foramen of Magendie
Foramina of Luschka, is it Lateral or Medial? Lateral
What makes the CSF? Choroid plexuses located in the lateral and fourth ventricles
Where are the choroid plexuses located? Lateral and Fourth ventricles
What structures reabsorb the CSF from the Foramina of Luschka and Magendie? Arachnoid granulations, which then drain into the dural venous sinuses
CSF in the arachnoid granulations is drain into the: Dural venous sinuses
Which are the 4 Cranial nerves above the Pons? I, II, III, and IV
Which 4 CNs exit the pons? V, VI, VII, and VIII
Which 4 cranial nerves are in the medulla? IX, X, XI, and XII
Which cranial nerve nuclei are MEDIAL ? III, IV, VI, and XII
What is common in CNs 3, 4, 6, and 12? Nuclei are medial
Actions or roles of the Pineal gland: 1. Melatonin secretion 2. Circadian rhythms
The circadian rhythm and melatonin secretion are actions performed by the __________ ___________. Pineal gland
What is the function of the Superior colliculi? Direct eye movements to stimuli or objects of interests
The inferior colliculi is involved in __________________. Auditatory
Where are the nuclei of the cranial nerves? In tegmentum portion of brain stem
Which CN nuclei are located in the midbrain? III and IV
Which cranial nerve nuclei are located in the Pons? CN V, VI, VII, and VIII
What structure is known to divide the lateral nuclei from the medial nuclei of the cranial nerves? Sulcus limitans
Cranial nerve LATERAL nuclei = Sensory (alar plate)
Cranial nerve MEDIAL nuclei = Motor (basal plate)
CN nerves in the medulla: CN IX, X, XII
Which cranial nerve's nucleus in in the Spinal cord? CN XI
Associated foramina of the Anterior cranial fossa? Cribriform plate
Which cranial nerve goes through the Cribriform plate? CN I
What structures (nerve/artery) pass through the Optic canal? CN II and Ophthalmic artery
Which foramen is used by the CN II? Optic canal
Which canal is used by the Ophthalmic artery? Optic canal
What are the associated foramina of the Middle Cranial fossa? 1. Optic canal 2. Superior orbital fissure 3. Foramen Rotundum 4. Foramen Ovale 5. Foramen Spinosum
What cranial nerves are known to pass through the Superior orbital fissure? CN II, IV, VI, and V1.
Which foramen is used by CN V2? Foramen Rotundum
Which foramen is used by CN V3? Foramen Ovale
Foramen Rotundum provides passage to which cranial nerve? CN V2
Foramen Ovale is used by which cranial nerve? CN V3
What structure goes through the Foramen Spinosum? Middle meningeal artery
The MMA uses which middle cranial fossa foramen? Foramen spinosum
Anterior cranial fossa is through the Ethmoid bone
Which cranial fossa is associated with "through sphenoid bone"? Middle cranial fossa
Through temporal or occipital bone. Cranial fossa? Posterior cranial fossa
What are the foramina associated with the Posterior cranial fossa? - Internal auditory meatus - Jugular foramen - Hypoglossal canal - Foramen magnum
What cranial nerves go through the Internal auditory meatus? CN VII and CN VIII
Which foramen is used by cranial nerves VII and VIII in the Posteror cranial fossa? Internal auditory meatus
Damage to the Jugular foramen will probably damage which cranial nerves and vein? CN 9, 10, 11, and Jugular vein
What foramen is used by Cranial nerve XII? Hypoglossal canal
What structures traverse by the Foramen magnum? 1. Brain stem 2. Spinal root of CN XI 3. Vertebral arteries
Which foramen is used in the Posterior cranial fossa by the Brain stem and Vertebral arteries? Foramen magnum
What is the associated cranial nerve that goes through the Foramen Magnum? Spinal root of CN XI
Created by: rakomi
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