200 terms

pamhong-USMLE step 1 neuro

high NE
low NE
high DA
low DA
parkinson's and depression
low seratonin
anxiety and depression
low Ach
Alzheimer's huntington, REM sleep
low gaba
anxiety, huntington
glutamine + vit b6
NE synth location
locus cerules/reticular formation/solitary tract
DA synth formation
ventral tegmentum, SNc
seratonin synth location
raphae nucleus
ACh synth location
basal nucleus of meynert
GABA synth location
nucleus accumbens
DA ptwy: mesocotical block
ventral tegmentum of MB to cortex.
blocked: increase positive Sx of schizophrenia
Da ptwy: mesolimbic
ventral tegmentum of MB to limbic system.
blocked: relief of pschosis (+Sx)
DA ptwy: nigrostriatal
substantia nigra par compacta to striatum (caudate and putamen).
blocked: parkinson dz/ stimulation: extrapyramidal a/e
DA pwty: tuberoinfendibular:
arcuate nucleus of hypoth to pituitary
blocked: increases prolactin- sx: amnorrhea, gynecomastia, galactorrhea
reticualr acivating system
locus cerelus, reticular formation and raphae nuclei. Mediates cosciousness and alertness bc synth 5ht,NE. Damge: coma.
free nerve ending
pain and temp.
a-delta and c-fiber
free nerve ending. slow unmyelinated. warm temp
A delta fibers
free nerver ending. fast, meylinated, cold temp
meissner's corpuscle
large, meylinated. hairless skin (superficial skin)
position and dynamic touch
fast adapting
pacinan corpuscle
lg, meylinated (deep skin), ligaments, joints. fast adapting
vibration and pressure
merckle's disk
hair follicle.(superficial skin)/ slow adapting
position, static touch-edges, textures
encapsulated/ slow adapting/
deep layers. sole of foot
BBB composition
1. tight junctions b/w NON-fenestrated capillary endothelial cells (destruction- vasogenic edema)
2. BM 3. astrocyte processes
BBB permeability
glucose and AA cross via carriers- slow
lipid-soluable and non-polar- fast via diffusion
non BBB, fenestrated capillaries in brain
1. area postrema- vomiting after chemo (CZT at medulla)
2. OVLT- osmotic sensing 3. neurosecretory products- ex: ADH
supra optic nucleus
hypothalamus nuclei- makes ADH
paraventricular nucleus-
hypothalamus nuclei- makes oxytocin
lateral area of hypothalamus
FN- hunger. Inhibited by leptin
destructionn- anorexia, failure to thrive (infants)
zap lateral you shrink laterally
ventromedial area of hypothalamus
FN- satiety. stimulated by leptin
destruction by craniopharyngioma- hyperphagia
zap ventromedial you grow ventral and medial
antetior hypothalamus
cooling, parasymp.
A/C- anterior cooling
posterior hypothalamus
heating, symp
suprachiasmatic nucleus
circadian rhythm
thalamus: VPL
input: spinothalmic / dorsal coums and medial lemniscus
info: pain and temp (from body)
output: primary somatosensory cortex.
thalamus: body sensation
thalamus: VPM
input: trigeminal and gustatory ptwy
info: face sensation and taste
output: primary somatosensory cortex
thalamus LGN
input: CN II
info: vision
output: calcarine sulcus (occipital lobe)
thalamus: MGN
input: superior olive and inferior colliculus of pons
info: hearing
output: auditory cortex (temporal lobe)
thalamus: communication w/ prefrontal cortex . damage?
mediodorsal (MD) nucleus
dmaage: memory loss
thalamus: cerebellum (dentate n.) and basal ganglia
thalamus: VA
basal ganglia to prefrontal, premotor, and orbital cortices
thalamus: anterior nuclear group
mamillothalmic tract to cingulate gyrus
part of papez circuit
thalamus: pulvinar
integration of vision, auditory, and somesthetic input
cerebellum input
contralateral cortex via middle cerebellar peduncle
ipsilateral proprioception via inferior cerebellar peduncle
nerves: climbing and mossy fiber
cerebellum output
contralateral cortex via superior cerebellar peduncle
nerves: purkinje fibers
modulates movement
vermis and paravermis via fastigial and interposed nuclei
interposed n = globise and emboliform
flocculonodular lobe and vermis via fastigial nuclei
lateral hemispheres via dentate
cerebellum nuclei
lateral to medial: dont eat greasy food
dentate, emboliform, globose, fastigial
lateral cerebellum
voluntary movement of extremities
medial cerebellum
balance, truncal coordination, ataxia
injury: ipsilateral - falls to injured side bc info crosses twice
basal ganglia: direct ptwy
NT: dopamine receptor: D2R
SNc + , + striatum, - GPi, + thalamus = movement
basal ganglia: indirect ptwy
NT: dopamine receptor D2R
+SNc, - striatum, +GPe, -Subthalmic n.& Gpi, +thalamus = movement
basal ganglia: GPi
decrease/inh mov
basal ganglia: GPe
inhibits STN and Gpi = increases movement
basal ganglia: STN
stimulated GPi = inhibits movement
basal ganglia and PD
loss of DA= less direct ptwy , more indirect ptwy = less motion
basal ganglia and HD
neuronal death via NMDA-R : glutamate toxicity
atrophy of striatal nuclei (main inh of mov)
multiple sysmtem atrophy:
parkison-like, autonomic dysFN, ataxia
inclusion w/ alpha synuclein in oligodendroglia cells
paramedian pontie reticular formation (PPRF) lesion
eyes look away from lesion
frontal eye fields lesion
eyes look towards lesion
cerebellar hemisphere lesion
intention tremor, limb ataxia, ipsilateral
cerebellar vermis lesion
TRUCAL ataxia, dysarthia
reticular activating system (MB) lesion
reduced levels of arousal and wakefulness = coma
superior colliculi lesion
paralysis of upward gaze
left parietal lobe lesion
gerstman syndrome- agraphia, acalculia, finger agnosia, left and right disorientation
bilateral amygdale lesion
kluber-bucy syndrome: hyperorality, hypersexuality, disinhited behavior
central pointine myelinosis
acaute paralysis, dipliopia, loss consciousness.
bc rapid correction of HYPO-natremia
broca's aphasia
nonfluent aphasia but understands
INFERIOR frontral gyrus
wernecke's apahsia
fluent aphasia, but impaired comphrehension
SUPERIOR temporal gyrus
global apahsia
nonfluent and impair comprehension. both broca and wernecke
conduction aphasia
poor repetition. pt understands and is able to speak but no connection. At arcuate fasciculus
non-dominant broca aphasia
expressive dysprosody- can't express emotions/inflection on speech "monotone"
non-dominant wernecke apahsia
receptive dysprosody- inability to comphrehend emotion or inflectionin speech
weber's syndrome
midbrain infarct occlusion of paramedian branches PCA
contralateral hemiparesis (CST) & oculomotors CN III palsy
CN 3
rostral midbrain.
levator palpebrae, superior, inferiorm, and medial rectus. inferior oblique/ pupillary sphincter- ciliary muscle
Cn 4
caudal midbrain- superior oblique
CN 6
caudal pons- lateral rectus
anterior spinal art
contralat- hemiparesis (LE), ipsilateral paralysis of CN9
pain and temp are ok
PICA/ lateral medullary/wallenberg
contralat- pain and temp in BODY
ipsilat- dysphagia, decrease gag reflex, dipliopia, nystagmus, horner's, facial tmep and pain, ataxia
AICA/ lateral inferior pontine synd
ipsilateral facial paralysis (cn7), cochlear n. & nystagmus (cn8), facial pain & temp
contralat- hemianopoa w/ MACULAR SPARING
contralat- face, arm paralysis/sensation, apahsia(dominant), left side neglect (non-dominant)
contralat- leg-foot motor and sensory
anterior communicating art
MC site of berry aneurysm. visual problems- bitemporal hemianopsia
posterior communicating art
CN 3 palsy- down and out
lateral striate
from MCA. pure motor hemiparesis (arms & legs)
internal capsule, caudate, putamen, GP. "arteries of stroke"
watershed zone
b/w ACA and MCA or MCA and PCA
HYPOtension,upper leg + arms weakness, high order visual process
basilar art
locked in syndrome. only CN3 is intact!
aneurysm causes
APKD, marfan, ehlers danlos
charcot bouchard microaneurysm
ass w/ chronic HTN- small vessel in basal ganglia and thalamus
stroke at thalamus
only sensory loss in cotralateral side both arms and legs. no motor defecit. but difficult to walk bc loss of proprioception
CCB used after aneurysm to decrease risk of vasospam
parenchymal hematoma
HTN, amyloid angiopathy- lobar stroke, DB, CA
at basal ganglia and internal capsule
intraventricular hemorrhage
PREMES < 32 wks , low birth wgt < 1500
ischemic stroke
emboli. a-fib, carotid dissection, patent foramen ovale, endocarditis, lacunar stroke-HTN.
cystic cavity w/ reactive gliosis.
reversible. < 24 hrs
dural venous sinus
superior sagital sinus (main location of CSF return) --> confluence of the sinus --> transverse sinus--> sigmoid sinus --> int. jugular v.
where does the sigmoid sinus become IJV
jugular foramen
foramen of monro
latreal ventricle to 3rd ventricle
cerebral aqueduct
3rd to 4th ventricle
made in choroid plexus/ reabsorbe by choroid sinus
foramen of luschka
4th ventricle to subarachnoid space. LATERAL
foramen of magendie
4th ventricle to subarachnoid space. MEDIAL
normal pressure hydrocephalus
wet, wobbly, wacky. NO increase in volume.
dementia, ataxia, urinary incontinence
young, obese female w/ daily HA worse in AM and papilledema
N- ventricles, no tumor/masses. but HIGH csf press.
tx- lose wgt, acetozolamide
fasciculus cuneatus
dorsal column- upper extremities
fasciculus gracilis
dorsal column- lower extremities. (more medial)
lateral CST
arms are medial, legs are lateral
polio & werdnig hoffmann dz
LMN lesion - destructoin anterior horns- flaccid paralysis
anterior spinal art and cord
lose everything but dorsal columns and tract of lissauer. (proprioception, touch and temp ok)
3 syphilis
DRG and dorsal column lesion
vit b12, vit E def, friedreich ataxia
dorsal coumn, lateral CST, spinocerebellar tract
ataxia, hyperreflexia, impair vibration. ok temp & pain
polio CSF
lymphocytic pleocytosis no protein.
friedreich ataxia
AR. repeat dz- GAA. frataxin protein. inpaired mitochondria. freq falling, nystagmus, dysarthia, hypertrophic CMP, kid- kyphoscoliosis. loss of CN8, 10, 12, cerebellum
brown sequad syndrome
ipsilateral- UMN. tactile, vibration, sensation, LMN
contralat- pain and temp below lesion
posterior half of skull
turtle neck shirt
clavicle region. low collar shirt
xiphoid process
inguinal lig
kneecaps "down in all fours"
erection and sensation of penile and anal zone
reflex s1,2
reflex L3,4
reflex C5.6
reflex C7,8
moro reflex "hang on for life"
baby opens arms when thinks is falling backwards
CN that lie medial in brain stem
CN 3-MB, CN 6- pons, CN 12- medulla.
CN 7
motor- facial mov, eyelid closing, stapedius muscle in ear
sensory- taste ant 2/3 tongue, lacrimation, salivation
sensory- taste post 1/3 tongue, salivation-parotid, monitoring carotid body & sinus-chemo R
motor- swallowing, stylopharyngrus (elevates pharynx, larynx)
Cn 10
sensory- taste epiglottic region, aortic chemo & baro-R,
motor- palate elevation, midline uvula, talking, coughing
thoracoabd viscera
corneal reflex and lacrimation
afferent- V1
efferent- cn 7
jaw jerk
V3 sensory, v3 motor both via masseter
gag reflex
cn9 afferent,
cn 9, 10 efferent
vagal nuclei: n. solitarius
visceral sensation- taste, baro-R, ut distantion. CN 7,9,10
vagal nuceli: n. ambiguous
motor innervation pharynx, larynx, upper esophagus- Cn 9, 10, 11
dorsal motor nucleus
vagal nuclei. sends autonomic (parasymp) fibers to heart, lung, GI
ear: webber test
turning fork in middle top head.
n- hear it on both ears = midline
conduction defect- ipsilateral
sensory defect = contralateral
ear: rinne test
fork at mastoid then at ear.
conduction defect= AC<BC
ear: webber-R
Rinne LE: AC>BC, RE: BC>AC
R- webber--> R-conduction or L- sensory
rinne- LE ac>bc normal
rinne-RE bc>ac conduction
cavernous sinus
CN 3,4,5 (V1, V2) ,6
internal carotid and post ganglionic symp
carvernous sinus syndrome
ophthalmoplegio, ophthalmic and maxillary sensory loss
ass- w/ infections b/w nose and lip.
uvula deviation to the left
1. Cn 10 and nucleus ambiguous on the RIGHT
2. corticobulbal tract/motor cortex on the LEFT
tongue deviation to the left
1. Cn 12 Left
2. CBT / motor cortex on R
can't turn head to left, and should droop on R
CN 11 on R.
palsy of lower face
UMN lesion think of stroke.
upper face is innervated by both UMN so the ipsilateral UMN still functional
palsy entire half of face
bell's palsy. damage at nuclei. LMN
causes of Bell's palsy
Lovely Bella Had An STD
lyme, HSV, Aids, Sarcoidosis, Tumor, DB
bilateral bell's
lyme dz, guillian barre
open angle glaucoma
obstruction at canal of schlemn
slow, oainless, bilateral
close angle galucoma
obstruction of flow from posterior to anterior chamber.
painful, acute, rock hard eye, frontal HA, halos, raindown around lights, non-reactive pupil
dont give EPI: miadriasis
cataracts/ congenital/ risk
opacity of lens. / congenital- rubella
classical galactosemia, galactokinase def, DB
CN 4 damage
eye drifts upward- vertical dipliopia
problems reading, going town the stairs
CN 6 damage
medially directed eye
pupilary pschincter muscle. parasymp Cn 3 from EW n. to ciliary ganglion.
radial muscle, symp. T1 preganglionic- sup cervical ganglkion- postgl. symp- long ciliary nerve.
marcus gunn pupil
damage in CN2. shine light in one eye- both dilated/ shine light on ok eye- both constrict. AFFERENT problem
macular degeneration dry vs wet
loss of central vision.
dry- slow- fat deposits
wet rapid. neovascularization
damage to optic tract on R
loss of right retina field.= loss of left visual field
homonymous hemianopia
damage to meyer's loop on R
in temporal lobe
L upper quadrant anopia.
damage to dorsal optic radiation R
parietal lobe MCA
L lower quadrantic lesion
lesion of MLF causes palsy of medial rectus (Cn3) when looking laterally. the normal eye moves laterally and has nystagmus.
both eyes goinward on accomodation.
senile plaques: b-amyloid (dark cotton balls)
neurofibrillary tangles- TAU phosphorylation (flame shape)
pick's dz
frontotemporal dementia
dementia, aphasia, change in personality
pick's body- ROUND tau, stains w/ silver
lewy body dementia
parkinson w/ dementia, VISUAL hallucinations, repeated falls, and syncope.
alpha-synuclein defect (lewy body)
oligoclonal bands (IgG to oligodendroglia cells)
periventricular plaques
guillain barre'
motor fibers. symmetric. ascending/ autonomic dysFN
CSF- high protien no WBC / papilledema
ass w/ campylobacter
JC virus - destruction of oligodentroglia
acute disseminated (post inf) encephalomyelitis
multifocal inflamm and demyelination after infection. no necrosis. ass w/ kids and chickenpox/measles
metachromatic leukodystrophy
AR lysosomal storage dz
arylsulfatase A def. - impair production of myelin
charcot marie-tooth dz
hereditary- motor and sensory neuropathy
def in protein ass w/ meylin. - palpable perineal n. but thin calfs
constant demyelination/remyelination- onion bulb look
seizures general
1. absence- 3hz, no postictal confusion- blank stare
2. myoclonic- jerks
3. tonic-clonic- grand mal. stiff and jerks
4. tonic- stiff
5. atonic- drop. mistaken for fainting.
simple vs comple sz
simple- consciousness is intact.
complex- impaired consciousness
causes if sz by age
kids- genetic>inf>trauma
adults- tumors>trauma>stroke>inf
elderly- stroke> tumor>trauma>metabolic>inf
cluster HA
unilatral. brief HA. every day for several wks
tearing, runny nose! horner's
tx/; O2 +/- sumitriptan
tension HA
bilateral. > 30 mins. dull pain no othe associated sx
frontal-occipital region
unilatreal- pulsating, n/v, photophobia, phonophobia, possible aura. tx: sumitriptan for acute/ BB for prophylaxis.
trigeminal neuralgia
lightening pain, electrical shock like w/ min stimuli- bed sheets, wind.
tx- carbamezepine,
sturge webber syndrome
cong. port wine stain at trigeminal region (V1)
ipsilateral letomeningeal angioma
tuberous sclerosis
hamartomas in CNS, cadiac rhabdomyomas
renal angiolypomas. ashleaf spots
Von Hipple Lindau dz
cavernous hemangiomas in skin, mucosa
BILATERAL renal cell CA- increases epo
pheocrhomocytoma, hemangioblastoma in cerebellum
MC 1 tumor adults GFAP+ / pesudopalisading cells
hemispheres. crosses corpus callosum. / necrosis.
2nd MC in adults
whorled pattern. psammoma bodies - calcification rings
3rd MC in adults. resectable S-100 +
bilateral aucustic schwannoma - NF2
slow growing. frontal lobes. GFAP +
fried eggs cells and chicken wire capillary
pilocytic astrocytoma
kids. GFAP + usually at cerebellum - cyst and solid
rosenthal fibers- eosinophilic corckscrew fibers
cerebellar tumors kids. PNET
homer-wright rosettes. small blue cell Ca
at 4th ventricle. kids. hydrocephalous.
perivascular pseudorosettes.(white area around BV)
kids. cerebellum w/ foamy cells. ass w/ vHL syndrome.
produces EPO- 2nd polycythemia
benign kids. from rathke's pouch- calcification- enamel like
bitemporal hemianopsia.
uncal herniation
ipsilateral- CN 3 palsy, paresis( compression crus cerebri-contralat)
contralateral- homonymous hemianopia (comp ipsilat PCA)
cingulate herniation
subfalcine. under falx cerebri.
compression ACA
downward transtectorial herniation
compression cerebral aqueduct- hydrocephalus
cerebellar tonsil herniation
into foramen magnum
ass w/ arnol chiari