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Step 1 - Neurology
Neurology
89
Medical
Graduate
03/28/2014

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Term
Neural development
Definition
notochord induces ectoderm to differentiate into neuroectoderm and form the neural plate
Neural plate - neural tube and NC cells
Notochrod - nucleus pulpous of spinal cord
Term
Prosencephalon
Definition
"Forebrain" (Pro Touchdown)
Telencephalon > cerebral hemisoheres
Diencephalon > thalamus
Term
Mesencephalon
Definition
"Midbrain"
Mesencephalon > Midbrain
Term
Rhombencephalon
Definition
"Hindbrain" (Have you met my aunt Rhonda?)
Metencephalon > Pons and cerebellum
Myelencephalon > Medulla
Term
Neural tube defects
Definition
Inc AFP in amniotic fluid
Inc AchE is a confirmatory test
Term
Anencephaly
Definition
Malformation of the anterior NT, no forebrain
Inc AFP, polyhydramnios (no swallowing center in brain)
*Associated with maternal diabetes
Term
Holoprosencephaly
Definition
Failure of the L and R hemispheres to separate
During weeks 5-6
Mutations i Sonic Hedgehog gene signaling pathways
Moderate form has cleft lip/palate, severe is cyclopia
Term
Arnold-Chiari Malformation
Definition
Tonisllar and vermian herniation through FM
Aqueductal stenosis and hydrocephalus
Presents with throaco-lumbar myelomeningocele and paralysis
Term
Dandy Walker Malformation
Definition
Agenesis of the cerebellar vermis with cystic enlargement go 4th ventricle
Assoc hydrocephalus and spina bifida
Term
Syringomyelia
Definition
Cystic enlargement of central canal of spinal cord
*Damage to crossing fibers first
*cape like distribution of bilateral pain and temp loss
Assoc with Chiari 1 Malformatiom
Term
Tongue development
Definition
1st branchial arch forms ant 2/3
3rd and 4th branchial arches form post 1/3
Motor innervation to tongue via 12
"1 mandible in 7, has 3/4 of teeth = 9, 12 being normal"
Arch= A(1), P(3/4)
Sens= A(V3), P(9)
Taste= A(7), P(9)
Term
Neuroectoderm
Definition
CNS neurons, ependymal cells, oligodendrocytes, astrocytes
Term
Neural Crest
Definition
PNS neurons, Scwhann cells
Term
Mesoderm
Definition
Microglia, like macrophages
Term
Neurons
Definition
Cell bodies and dendrites can be stained with Nissel substance (stains RER)
*no RER in axon
Term
Astrocytes
Definition
Physical support, repair, K metabolism, removal of excess NT, maintenance of BBB, Reactive gliosis in response to injury
Astocyte marker- GFAP
Term
Microglia
Definition
CNS phagocytes, mesodermal origin
Small irregular nuclei, little cytoplasm
Respond to damage by differentiating into large phagocytic cells
*HIV infected cells fuse to form multinucleated giant cells in CNS
Term
Myelin
Definition
Saltatory conduction between nodes of rangier, where there are high concentrations of Na channels
Term
Oligodendroglia
Definition
Each cell myelinated multiple CNS axons
Appear as small nuclei with dark chromatin and little cytoplasm
Predominant cell type of glial cell in white matter
*fried egg cells on H&E stain
Term
Schwann cells
Definition
Each cell only melinates one axon
Promotes axonal regeneration
Inc conduction via saltatory conduction
High concentrations of Na channels, between nodes
*destroyed in Guillain-Barre
Term
Free nerve endings
Definition
Pain and temperature
C- slow, unmyelinated fibers
Adelta- fast, myelinated fibers
Term
Meissner's corpuscles
Definition
Large, myelinated
*hairless skin
Dynamic, fine/light touch; proprioception
Term
Pacinian corpuscles
Definition
Large, myelinated fibers "onion"
Deep skin layers, ligaments, joints
Vibration, pressure
"Pack it in deep to prevent vibration and pressure"
Term
Merkel's discs
Definition
Large myelinated fibers, adapt slowly
Hair follicles
Pressure, deep static touch, position sense
Term
Peripheral Nerve
Definition
Endoneurium- single nerve fiber layers (inflammatory infiltrate with guillan barre)
Perineurium- Surrounds a fascicle of nerve fibers. Must be rejoined in microsurgery for limb reattachment
Epineurium- dense CT that surrounds entire nerve
Term
NE
Definition
Inc anxiety, dec depression
*locus ceruleus (pons)
Term
DA
Definition
Inc schizophrenia, Dec in parkinsons and depression
In Ventral Tegmentum and SNc (midbrain)
Term
Serotonin
Definition
Dec anxiety, dec depression
Raphe Nucleus (Pons)
Term
Ach
Definition
Dec in Alzheimers and huntingtons, Inc in REM sleep
Basal Nucleus of Meynert
Term
GABA
Definition
Dec anxiety, dec Huntingtons
Nucleus Accumbens
Term
Blood Brain Barrier
Definition
Tight junctions between nonfenestrated capp endothelial cell
BM
Astrocyte foot processes
*Glucose and AA cross via carrier mediated transport
*nonpolar/lipid soluble substances can cross rapidly via diffusion
Term
Brain regions with fenestrated capillaries
Definition
Area postrema- vomiting after chemo
OVLT- osmotic sensing
Neurohypophysis- secretes ADH right into blood
Term
Hypothalamus
Definition
Thirt and water balance
Adenohypophysis
Neuroypophysis
Hunger
Autonomic regulation
Temperature
Sexual urges

Supraoptic nucleus- makes ADH
Paraventricular nucleus- makes oxytocin
Term
Areas of hypothalamus
Definition
Lateral area, ventromedial area, anterior hypothalamus, posterior hypothalamus, suprachiasmatic nucleus
Term
Lateral Area (HT)
Definition
Hunger, inhibited by Leptin
Destruction leads to anorexia
"If you zap your lateral nucleus, you shrink laterally"
Term
Ventromedial area (HT)
Definition
Satiety, stimulated by leptin
Destruction leads to hyperphagia
"If you zap the VM area you grow ventrally and medially"
Term
Anterior Hypothalamus
Definition
Cooling, parasympathetic
A/C= cool off
Term
Posterior Hypothalamus
Definition
Heating, sympathetic
Term
Suprachiasmatic nucleus
Definition
Circadian Rhythym, master clock
Term
Poterior Pituitary
Definition
Receives hypothalamic axonal projections
Supraoptic- ADH
Paraventricular- Oxytocin
Term
Thalamic regions
Definition
VPL, VPM, LGN, MGN, VL
Major relay for all ascending sensory information except olfaction
Term
VPL (T)
Definition
Spinothalamic, dorsal columns/medial lemniscus
Pain and temperature; pressure, touch, vibration and proprioception
Primary somatosensory cortex
Term
VPM (T)
Definition
Trigeminal and gustatory pathway
Face sensation and taste
Primary somtatosensory cortex
"Makeup goes on the face"
Term
LGN
Definition
CN2
Vision
Calcarine sulcus
(Lateral = light)
Term
MGN
Definition
Superior olive and inferior colliculus of tectum
Hearing
Auditory cortex of the temporal lobe
(medial= music)
Term
VL
Definition
Basal ganglia
Motor
Motor cortex
Term
Limbic system
Definition
Emotion, long term memory, olfaction, behavior modulation and autonomic nervous system function
Hippocampus, amygdala, fornix, mammillary bodies, cingulate gyrus
*Feeding, fleeing, fighting, feeling and fucking
Term
Cerebellum
Definition
Modulates movement
Deep Nuclei (lateral to medial)- dentate, emboliform, globose, fastigial
Lateral- voluntary movement of extremities
*Fall towards injured side
Medial- balance, truncal coordination
Term
Cerebellar input
Definition
contralateral cortex (middle cerebellar peduncle)
ipsilateral proprioceptive information (inf cerebellar peduncle)
All done by mossy and climbing fibers
Term
Cerebellar output
Definition
Sends information to contralateral cortex to modulate movement
Done by purkinje fibers
Term
Basal Ganglia
Definition
Important in voluntary movements and making postural adjustments
Striatum- putamen + caudate
Lentiform- putamen + globus pallidus
D1 receptor= direct
Term
Basal Ganglia pathways
Definition
SNc > neo striatum > inhibitory to the GPi and GPe
GPe > STN inhibitory > GPi excitatory
GPi > thalamus > cortex > etc.
Excitatory- Stim release of GABA which disinhibits the thalamus vis GPi/SNr (INC motion)
Inhibitory- stim striatum, which disinhibits STN via GPe and STN stimulates GPi to inhibit thalamus
Term
Parkinson's disease
Definition
Degenerative disorder of the CNS assoc with Lewey bodies (composed of a-synuclein) and loss of DA neurons in substantia nigra pars compact
Term
Huntington's disease
Definition
AD trinuc repeat disorder (CAG)
Chorea, aggression, depression and dementia
*neuronal death via NMDA-R binding and glutamate toxicity
Atrophy of stratal nuclei
Caudate loses Ach and GABA
Term
Hemiballismus
Definition
Wild flailing of one are and ipsilateral leg
Contralateral subthalamic nuclei (lacunar stroke)
Term
Amygdala lesion
Definition
Kluver-Bucy syndrome
Assoc with HSV-1
Term
Right Parietal Lobe
Definition
Spatial Neglect Syndrome
Agnosia of the other half of the world
Gerstmann Syndrome
Agraphia, acalculia, finger agnosia, L+R discrimination
Term
Reticular Activating System
Definition
Reduced levels of arousal and wakefulness
Term
Mammillary Bodies
Definition
Wernicke-Korsakoff syndrome
Confusions, opthalmoplegia, ataxia, memory loss, confabulation, personality changes
*Assoc with thiamine deficiency, EtOH use
*can be precipitated by giving glucose without B1
Term
Cerebellar hemisphere
Definition
Fall toward side of lesion
Term
Cerebellar vermis
Definition
Truncal ataxia, dysarthria
Term
Subthalamic nucleus
Definition
Contralateral hemiballimsus
Term
Hippocampus
Definition
Anterograde amnesia
Term
PPRF
Definition
Eyes look away from the side of the lesion
Term
Frontal eye fields
Definition
Eyes look towards the side of the lesion
Term
Central Pontine Myelinosis
Definition
Overly rapid correction of Na levels
Can cause locked in syndrome: Acute paralysis, dysarthria, dysphagia, diplopia, and LOC
Massive axonal demyelination in pontine white matter tracts
Term
Brocas Aphasia
Definition
Nonfluent- unable to speak, but can comprehend just fine
Inferior frontal gyrus of frontal lobe
Term
Wernicke's aphasia
Definition
Fluent aphasia- impaired comprehension, babbling
Superior temporal gyrus of temporal lobe
Term
Global aphasia
Definition
Non fluent aphasia with impaired comprehension
Both areas affected
Term
Conduction aphasia
Definition
Poor repetition but fluent speech, intact comprehension
Damage to the arcuate fasiculus
Term
MCA Stroke
Definition
- Contralateral paralysis of upper limb and face
- Contralateral loss of sensation upper limb and face
- Aphasia if in the dominant hemisphere. Hemineglect if in the non dominant hemisphere
Term
ACA Stroke
Definition
- contralateral paralysis lower limb
- contralateral loss of sensation lower limb
Term
Lateral striate artery Stroke
Definition
Striatum, internal capsule
- contralateral hemiparesis/hemiplegia
Common location of lacunar infarcts
Term
ASA Stroke
Definition
Lateral corticospinal tract, medial lemniscus, caudal medulla
- contralateral hemiparesis lower limbs
- contralateral dec proprioception
- ipsilateral hypoglossal dysfunction (tongue deviates ipsi)
Term
Medial medullary syndrome
Definition
infarct of the paramedian branches of ASA and vertebral artery, commonly bilateral
Term
PICA Stroke
Definition
Lateral medulla
- vomiting, vertigo, nystagmus, dec pain temp on limbs and face, dysphagia, hoarseness, dec gag reflex; ipsilateral horners, ataxia, dysmetria
Term
Lateral Medullary Syndrome
Definition
Nucleus ambiguous effects are unique to PICA
Term
AICA Stroke
Definition
Lateral pons, middle and inferior cerebellar peduncles
- vomiting, nystagmus, paralysis of face, dec lacrimation, dec taste from ant/2/3 tongue, dec corneal reflex, dec pain and temp on face, ipsilateral hearing decrease, horners
Term
Lateral pontine syndrome
Definition
Facial nucleus effects are specific to AICA
Term
PCA Stroke
Definition
Occipital cortex, visual cortex
- contralateral hemianopia with macular sparing
Term
Anterior communicating artery Stroke
Definition
common site of berry aneurysm
- visual field defects
Term
Posterior communicating artery stroke
Definition
common site of berry aneurysm
- CN 3 palsy (down and out)
Term
Berry aneurysm
Definition
Bifurcations in the circle of willis
Rupture leads to subarachnoid hemorrhage or hemorrhagic stroke
Can cause bitemporal hemianopia via compression of the optic chasm
Assoc with ADPKD, Ehler's Danlos and Marfans
Term
Charcot Bouchard Aneurysm
Definition
Assoc with chronic HTN, affects small vessels
Basal ganglia, thalamus
Term
Epidural hematoma
Definition
Rupture of the middle meningeal artery, branch of maxillary
Lucid interval
CN 3 palsy
*lentiform collection, not crossing suture lines
Term
Subdural hematoma
Definition
Rupture of bridging veins. Slow venous bleeding
Seen in elderly individuals, alcoholics, shaken baby
*crescent shaped crosses suture lines
Midline shift, cannot cross falx
Term
Subarachnoid hemorrhage
Definition
Rupture of an aneurysm such as berry or an AVM
Worst HA of my life
Bloody or yellow spinal tap 2-3 days afterwards
Risk of vasospasm due to blood breakdown
Term
Intraparencymal hemorrhage
Definition
Most commonly caused by systemic HTN
Also seen with amyloid angiopathy.
Occurs in basal ganglia and internal capsule
Term
Ischemic brain disease
Definition
Irreversible damage begins after 5 min of hypoxia
Most vulnerable: hippocampus, neorcortex, cerebellum, watershed areas
12-48: red neurons
24-72: necrosis and neutrophils
3-5d: macrophages
1-2wk: gliosis, vascular proliferation
2wek: glial scar
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