Neuro

Question 1

Which vessel is most commonly affected by cerebrovascular accidents?

Answer 1

the MCA (middle cerebral artery)

Question 2

What structures does the MCA supply?

Answer 2

• -Lateral surfaces of the frontal, parietal and upper temoral lobes
• -the internal capsule
• -most of the basal ganglia

Question 3

What symptoms would be expected with occlusion of the MCA?

Answer 3

• -aphasia (e.g., Broca’s or Wernicke’s) if the stroke occurred in the language-dominant hemisphere (usually left)
• -Hemineglect if the stroke occurred in the non-dominant hemisphere (usually right)
• -anesthesia of the contralateral face and upper limb
• -Spastic paresis of the contralateral lower face and upper limb.

Question 4

Describe Broca’s aphasia

Answer 4

characterized by slow, nonfluent speech with deficits in word-finding. Because comprehension is normal, patients are able to follow commands, they are typically aware of the problem, and can be frustrated.

Repetition, writing, and reading aloud is often impaired, but reading comprehension is often preserved.

Question 5

Describe Wernicke’s aphasia

Answer 5

Speech is nonsensical but fluent (word salad), and the patient as a lack of both comprehension and awareness of his or her syndrome.

Question 6

What symptoms would arise from occlusion of the ACA?

Answer 6

spastic paralysis and anesthesia (loss of sensation) of the contralateral lower limb.

urinary incontinence may be present (usually present with bilateral damage)

Question 7

What does the posterior cerebral artery (PCA) supply?

Answer 7

• -occipital lobe
• -thalamus
• -part of the temporal lobe

Question 8

How does occlusion of the PCA present?

Answer 8

with a homonymous hemianopia of the contralateral visual field with macular sparing

Question 9

What artery supplies the lateral medulla?

Answer 9

The PICA (posterior inferior cerebellar artery)

Question 10

What syndrome is caused by occlusion of the PICA?

Answer 10

Wallenberg syndrome (lateral medullary syndrom)

Question 11

How does Wallenberg syndrome present?

Answer 11

• -Ipsilateral limb ataxia
• -ipsilateral loss of pain and temperature sense from the face
• -contralateral loss of pain and temperature sense of the body
• -ipsilateral Horner’s syndrome
• -hoarseness
• -dysphagia
• -nausea and vomiting
• -vertigo
• -nystagmus

“Don’t pick a (PICA) horse (hoarseness) that can’t eat (dysphagia)

Question 12

How would a lesion of the trigeminal nerve present?

Answer 12

• -Ipsilateral loss of sensation to the face (anesthesia of the ipsilateral face)
• -The trigeminal nerve (V1) is also the afferent limb of the corneal reflex, which would also be impaired.

Question 13

What is the corneal relfex?

Answer 13

Involuntary bilateral blinking of the eyelids after stimulation of the cornea

Question 14

What are the histopathologic features of Alzheimer’s Disease?

Answer 14

(1) neurofibrillary tangles consisting of hyperphosphorylated tau protein
(2) extracellular senile plaques consisting of A-beta amyloid
(3) Granulovacuolar degeneration and Hirano bodies

Question 15

What are Hirano bodies?

Answer 15

rod-shaped, crystal-like and eosinophilic intracellular aggregates of actin

Question 16

When would we see gliosis of the caudate nucleus?

Answer 16

In Huntington disease

Question 17

What are the histologic features of Parkinson’s disease?

Answer 17

(1) Lewy bodies
(2) loss of pigmented neurons

Lewy bodies are eosinophilic intracytoplasmic spherules
The pigmented neurons are found in the substantia nigra

Question 18

What is the most common non-glial brain tumor in children?

Answer 18

craniopharyngeoma

Question 19

From what structure does a craniopharyngeoma arise?

Answer 19

From epithelial rests (remnants) derived from Rathke’s pouch.

Question 20

What tumors can lead to bitemporal hemianopia, and how?

Answer 20

Pituitary adenomas and craniopharyngeal tumors can lead to bitemporal hemianopia by compressing the optic chiasm

Question 21

What HLA haplotype is associated with MS?

Answer 21

HLA-DR2

Question 22

What are the most important clues in a patient case for MS?

Answer 22

• -well-circumscribed, demyelinated plaques seen on MRI (or autopsy)
• -Relapsing-remitting pattern of neurologic symptoms (motor and sensory) that are separated in time and space

Question 23

Where is the most common site of encephalocele?

Answer 23

the occipital bone

Question 24

Presentation of a lesion to the optic chiasm

Answer 24

bitemporal hemianopia

Question 25

Cause of a central scotoma

Answer 25

Lesions of the retina that include damage to the macula e. g.: - neurotoxins, such as ehtambutol - macular degeneration - optic neuritis (and therefore, MS could be a cause of central scotoma)

Question 26

What is the macula?

Answer 26

An oval region near the center of the retina that is approximately 3mm by 5mm and contains the fovea. It is responsible for central, high resolution vision.

Question 27

Hypoglossal nerve innervation

Answer 27

intrinsic muscles of the tongue: | genioglossus, hypoglossus, and styloglossus

Question 28

Lesion of what nerve would be responsible for hoarseness?

Answer 28

The recurrent laryngeal nerves

Question 29

From what cranial nerve does the recurrent laryngeal nerve branch?

Answer 29

Vagus

Question 30

What does the recurrent laryngeal nerve innervate?

Answer 30

All intrinsic muscles of the larynx, except the cricothyroid

Question 31

What is the connection between thyroidectomy and development of hoarseness?

Answer 31

The right and left recurrent laryngeal nerves ascend to the larynx by passing between the trachea and the esophagus, in close proximity to the thyroid gland. The recurrent laryngeal nerves are therefore particularly susceptible during thyroid surgery.

Question 32

Motor innervation of the glossopharyngeal nerve

Answer 32

The stylopharyngeus muscle and the parotid gland

Question 33

Afferent innervation of the glossopharyngeal nerve

Answer 33

visceral afferents and somatosensory visceral afferents supply: - -carotid sinus baroreceptors - -carotid body chemoreceptors - -mediate taste from posterior 1/3 of the tongue somatosensory fibers: - -supply pain, temperature, and touch information from the posterior 1/3 of the tongue - -upper pharynx - -middle ear - -eustachian tube

Question 34

Facial nerve innervation

Answer 34

- -muscles of facial expression - -lacrimal, submandibular and sublingual glands - -stapedius muscle - -mediates taste sensation from anterior 2/3 of the tongue

Question 35

Meningiocele

Answer 35

- -Failure of closure of the caudal portion of the neural tube - -Only the meninges herniate through a defect in the vertebral column and form a sac-like structure filled with CSF. - -Meningiocele is typically associate with only minial neurologic damage and is relatively easy to treat surgically.

Question 36

Meningiomyelocele

Answer 36

- -Occurs due to failure of closure of the caudal portion of the neural tube. - -Include herniation of the spinal cord along with meningeal tissue through a vertebral defect. - -Associated neurologic deficits are usually severe.

Question 37

Encephalocele

Answer 37

- -Caused by failure of closure of the neural tube at the rostal end - -Herniation of brain tissue through a bony defect in the skull

Question 38

Spina bifida occulta

Answer 38

- -Mildest of the neural tube defects - -typically consists of a small vertebral defect with normal spinal cord and meninges - -Often associated with a skin dimple or tuft of hair that overlies adipose tissue, hair follicles or a sinus.