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Step 1: Neuro Gold
| Question | Answer |
|---|---|
| Blood Brain Barrier | Isolates brain from body. Components include endothelial cells, basement membrane and astrocytic end feet. Circumventricular organs [area postrema, median eminence of the hypothalamus, neurohypophysis, pineal gland] lack a blood-brain barrier. |
| Myopathies | Associated with proximal symmetric weakness, but no sensory loss |
| Peripheral neuropathies | Cause distal asymmetric weakness with atrophy, fasciculations, sensory loss and pain. Peripheral neuropathies are most commonly caused by diabetes and alcoholism |
| Polyneuropathies | Sensory loss in a stocking/glove pattern |
| Guillain-Barre syndrome | Ascending symmetric muscle weakness 1-3 weeks following a viral respiratory or GI infection (campylobacter) |
| Amyotrophic lateral sclerosis | Most common motor neuron disease, gives rise to both upper AND lower motor neurons signs. |
| Multiple sclerosis | Weakness, blindness, sensory loss that resolve and return progressively worse. The diagnosis of multiple sclerosis requires two separate symptoms at two different times, or lesions separated in time and space. |
| Radiculopathies | cause pain/loss in a dermatomal pattern |
| Myasthenia gravis | Disease @ the NMJ, distinguished by fatiguability, show fatigue with repetitive stimulation of their muscles |
| Upper motor neurons | found mainly in the cerebral cortex; DO NOT directly innervate skeletal muscle. Upper motor neuron lesions = spastic paralysis, hyper-reflexia (muscle stretch reflexes are 3-4/4), Babinski sign, Hoffman sign. |
| Lower facial paralysis | damage to the corticobulbar tract in the pons or higher (e.g. internal capsule or crus cerebri). |
| Lower motor neurons | innervate skeletal muscle and are located in the spinal cord and brainstem. Lower motor neuron lesions = flaccid paralysis, hyporeflexia (muscle stretch reflexes are 0-1/4.) |
| Spinal shock | Sudden trauma to the spinal cord results in spinal shock (temporary flaccid paralysis, hyporeflexia, sensory loss and loss of bladder tone) – hyper-reflexia develops over a period of days to weeks |
| Occlusion of the artery of Adamkiewicz | results in anterior spinal artery syndrome = bilateral weakness, loss of pain and temperature and hyper-reflexia below the lesion |
| Cauda equina syndrome | weakness and sensory loss in the lower extremities, radicular pain, saddle anesthesia and urinary incontinence. |
| Spinal cord sensory levels | • C6=thumb • C7=middle finger • C8=little finger • T4=nipple • T6=xiphoid • T10=umbilicus • L4=medial knee • L5=big toe • S1=little toe |
| Muscle stretch reflexes | • C5=biceps • C6=brachioradialis • C7=triceps • L4=quadriceps • S1=Achilles |
| Muscle stretch reflexes measurements | • 0 = absent • 1 = trace or only with reinforcement • 2 = normal • 3 = brisk • 4 = clonus |
| Babinski sign | Scrap sole of the foot, flexion of toes is normal; extension = upper motor neuron lesion |
| Bing sign | Stab dorsum of foot with pin, normally plantar flex; dorsiflexion = upper motor neuron lesion |
| Abdominal reflex | scratch abdominal skin, absent in UM neuron lesion |
| Cremaster reflex | absent in UM neuron lesion |
| Hoffman sign | scrape tip of 3rd digit, thumb and 2nd digit flex in UM neuron lesion |
| Anal wink | scratch perineum to elicit contraction of external anal sphincter |
| Syringomyelia/Hyromelia | cavitation of the central spinal cord, impinges the anterior white commissure producing bilateral loss of pain and temperature in a dermatome distribution |
| Brown Sequard syndrome | hemisection of the spinal cord producing ipsilateral UMN paralysis and loss of discriminative touch and contralateral loss of pain and temperature |
| Anterior cord syndrome | results from compression of anterior spinal artery, affects the neurons of the anterior horn, spinothalamic tract and lateral corticospinal tract |
| Tabes dorsalis | loss of posterior columns (discriminative touch, proprioception and vibration) |
| Subacute combined degeneration | B12 deficiency, peripheral neuropathy that can progress to cord (posterior columns and lateral corticospinal tracts) |
| MEDIAL medullary syndrome | contralateral hemiparesis (corticospinal tract), ipsilateral deviation of tongue on protrusion (hypoglossal nucleus or nerve) & contralateral loss of discriminative touch, proprioception & vibration (medial lemniscus); blockage of ant spinal artery |
| LATERAL medullary syndrome | ipsilateral loss of pain/temperature on face, contralateral loss of pain/temperature on body, nystagmus, dizziness/nausea, hoarseness, ipsilateral sagging palate, dysphagia, loss of taste, ataxia, Horner syndrome; post. infer. cerebellar art |
| Tonsillar herniation | central apnea, hypertension, hyperventilation, loss of consciousness |
| Perinaud syndrome | paralysis of vertical gaze (vertical gaze center), obstructive hydrocephalus (pinealoma). |
| Foville syndrome | contralateral [spastic] hemiparesis (corticospinal tract), diplopia, paralysis of abduction (CN VI), ataxia (middle cerebellar peduncle), contralateral loss of discriminative touch, proprioception and vibration; paramedian branches of basilar |
| Gubler syndrome | contralateral [spastic] hemiparesis (corticospinal tract), ipsilateral facial paralysis (facial nerve or nucleus), ipsilateral loss of pain and temperature on face (CN V), contralateral loss of pain and temperature on body; paramedian branches of basilar |
| Midpontine base syndrome | contralateral [spastic] hemiparesis (corticospinal tract), paralysis of jaw muscles (CN V), loss of sensation on face (CN V), ataxia (middle cerebellar peduncle); paramedian and short circumferential branches of basilar. |
| Vestibular neuroma | tumor in the vestibular division of CN VIII; affects balance and hearing first (ipsilateral hearing loss), CN VII later, maybe CN V |
| Locked in syndrome | bilateral lesion of basilar pons; only CN III and IV are intact, vertical eye movements and blinking are intact |
| Weber syndrome | contralateral hemiparesis, diplopia, dilated pupil (CN III), paralysis of lower face, deviation of tongue to contralateral side, weakness of ipsilateral SCM and trapezius, tremor (substantia nigra); branches from posterior cerebral artery. |
| Uncal hernation | diplopia, dilated pupil (CN III), contralateral hemiparesis (corticospinal tract), paralysis of lower face, deviation of tongue to contralateral side, weakness of ipsilateral SCM and trapezius (corticonuclear tract). |
| Weber test | tests bone conduction; normally localize to midline – with sensorineuronal loss, localize to good ear; with conductive hearing loss, localize to bad ear |
| Rinne test | compares air and bone conduction; air conduction is normally better than bone conduction; with sensorineuronal loss, air>bone; with conductive hearing loss, bone>air |
| Anisocornia (unequal pupils) | lesion to CN III or sympathetics; a dilated pupil indicates injury to CN III. |
| VISUAL PATHWAY LESIONS | • Lesion to retina or optic nerve – ipsilateral blindness • Chiasm – bitemporal hemianopsia • Tract – contralateral homonymous hemianopsia • Radiations – contralateral homonymous hemianopsia, maybe quadrantanopia (“pie in the sky”) |
| Marcus Gunn pupil | a pupil that appears to dilate with direct stimulation of light on a swinging light test; indicates lesion to optic nerve |
| Argyll-Robertson pupil | seen in tabes dorsalis and is characterized by eyes that can accommodate but with weak or absent pupillary light reflex. |
| Decorticate posturing | UL flexed, LL extended [rubrospinal tract intact]; |
| Decerebrate posturing | all limbs in extension [rubrospinal tract damaged] |
| Reticular formation | functions mainly in muscle tone and state of consciousness |
| Meniere's syndrome | episodic vertigo, tinnitus and hearing loss; caused by excess endolymph in the scala media |
| Benign positional vertigo | outbursts of vertigo and nystagmus with particular positions of the head; caused by free otoliths in the semicircular canals |
| Parkinson's | characterized by loss of pigmented dopaminergic neurons in the substantia nigra, a 3-5 Hz resting tremor, bradykinesia and rigidity and Lewy bodies. |
| Huntington's | (characterized by choreiform movements and cognitive decline) – degeneration of neostriatum, especially caudate nucleus. |
| Wilson disease | Impaired copper metabolism, Kayser-Fleischer rings in cornea; tremor, dysarthria and rigidity |
| BALLISMUS | lesion to subthalamic nucleus; hemiballismus = subthalamic nucleus on opposite side. |
| Cerebellar disease | Ataxia and an intention tremor. Lesions of the cerebellar hemisphere impair movement on the ipsilateral side of the body. |
| Rhomberg test | in sensory ataxia patient sways considerably with eyes closed; in cerebellar ataxia they sway with eyes open. |
| Friedreich's ataxia | degeneration of posterior columns and spinocerebellar tracts |
| Blockage of MCA superior div | produces motor and sensory symptoms involving the contralateral face [lower facial paralysis], upper limb and trunk (lower extremity is spared); on the left will produce expressive (Broca’s) aphasia |
| Blockage of MCA inferior div | contralateral homonymous hemianopsia; on left receptive (Wernicke’s) aphasia |
| Blockage of anterior choroidal artery | produces contralateral hemiparesis (corticospinal tract) and contralateral homonymous hemianopsia (optic tract). |
| Blockage of lenticulostriate arteries | produces contralateral hemiparesis and hemianesthsia (posterior limb of internal capsule). |
| Blockage of anterior cerebral artery | motor and sensory symptoms involving the contralateral trunk and lower limb (upper limb and face are spared) with frontal lobe signs (magnetic gate, personality changes, release of primitive reflexes [grasp, root, suck]) |
| Blockage of posterior cerebral artery | produces visual symptoms – contralateral homonymous hemianopsia, macular sparring is possible; may infarct thalamus (thalamogeniculate and thalamoperforating) = contralateral homonymous hemianopsia/somatosensory loss |
| Broca’s aphasia | indicated by impaired comprehension, repetition, naming and speech output (left inferior frontal gyrus – pars triangularis and opercularis). |
| Dysarthria; aphasia | Dysarthria is a defect in the way speech sounds; aphasia is a defect in the use of language. |
| Wernicke's aphasia | characterized by fluent speech full of nonsense words and phrases (left temporal / parietal lobe). |
| Conductive aphasia | results from damage to the arcuate fasciculus and is characterized by poor repetition |
| stroke in anterior watershed area | expressive aphasia and lower limb affects |
| strokes in the posterior watershed area | produce receptive aphasia and visual loss. |
| Apraxia | indicates the loss of the ability to perform a learned and familiar motor task |
| Agnosia | indicates the inability to recognize a familiar object regardless of intact sense |
| Gertsmann syndrome | indicated by acalculia, agraphia, finger agnosia and left-right confusion. It is caused by damage to the angular gyrus in the dominant hemisphere. |
| Kluver Bucy | indicated by docility, placidity, hypersexuality, hyperorality and hypermetamorphosis. It is caused by bilateral lesions of the amygdala. |
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