Which areas of the brain do meningiomas most commonly occur?
- Convexities of the hemispheres and the parasagittal regions.
- Often attached to the dura. They arise from the meningioepithelial arachnoid cells that cover the brain and spinal cord.
What is the most common primary brain malignancy?
- these are malignancy astrocytomas (tumor of the supportive glial cells of the brain).
Describe GBM (e.g. location in brain, CT presentation)
- - most commonly occur in the cerebral hemisphere.
- - often crosses the corpus callosum, causing a "butterfly" appearance on CT.
This type of brain tumor arise from the cells that line the ventricles and parts of the spinal column. They often occur in children and are most commonly seen in the 3rd and 4th ventricle.
These are an abnormal buildup of blood vessels in the brain and other organs.
- 10% of patients with hemangiomas have associated Von-Hippel-Lindau syndrome.
This disease is autosomal dominant; leads to CNS tumors, hemangioblastomas, clear cell renal carcinoma, pheochromocytoma, and pancreatic neuroendocrine tumors.
These are CN VIII tumors that lead to sensorineural hearing loss (unilateral). They are common in the cerebellopontine area.
How is the motor component of CN V tested?
Closing jaw, moving chin side to side.
Motor: muscles of mastication
How is the sensory component of CN V tested?
Light touch with cotton wisp (to test the 3 divisions (branches) of the nerve:
- 1) ophthalmic (touch sclera)
- 2) maxillary
- 3) mandibular
What CN innervates the superior oblique (SO) muscle of the eye and what is its action?
CN IV (trochlear nerve)
- the SO muscle abducts, depresses and internally rotates the eye.
(remember "O" in oblique means "opposite" movement - as in superior --> moves inferior).
What CN innervates the lateral rectus muscle of the eye? XX
CN VI (abducens nerve)
What CN innervates the inferior oblique (IO) muscle of the eye and what is its action?
CN III (oculomotor nerve)
- the IO muscle makes the eye move upward and outward.
(remember "O" in oblique means "opposite" movement - as in inferior --> moves superior).
Which CN is tested when testing the muscles of facial expression (e.g. blinking of eyes, raising eyebrows, frown, smile, close eyes tightly, puff cheeks).
CN VII (facial nerve)
- motor: also includes tear glands
Which CN is tested when testing taste on anterior 2/3 of the tongue?
CN VII (sensory component)
- also somatic fibers to external ear.
____________ is an electrical sensation running down the back and into the limbs, especially when the neck is flexed.
- probably caused by hyperexcitability of the nerves which have been demyelinated (ex. MS)
(Pyramidal or extrapyramidal) ____(a)_____ tracts control (voluntary/involuntary) movements while (pyramidal or extrapyramidal) ____(b)_____ tracts control (voluntary/involuntary) movements.
- a. Pyramidal - voluntary
- b. extrapyramidal - involuntary
- - modulated/regulated by:
- 1. sensory part of cerebral cortex
- 2. basal ganglia
- 3. vestibular nuclei
- 4. cerebellum
These are involuntary spasms, repetitive motions or abnormal voluntary movements.
Dyskinesia (extrapyrimidal symptom)
These are sustained contractions (muscle spasm) especially of antagonistic muscles (ex. simultaneous biceps & triceps contraction) --> twisting of the body, abnormal posturing (ex. torticollis, writer's cramp).
Dystonia (extrapyrimidal symptom)
These are sudden, brief, sporadic involuntary jerking/twitching of 1 muscle or muscle group (not suppressible).
Myoclonus (extrapyrimidal symptom)
These are sudden, repetitive non-rhythmic movements or vocals using specific muscle groups.
- - These are suppressible (unlike myoclonus)
- - ex. Tourette syndrome
These are rapid involuntary jerky, uncontrolled, purposeless movements.
Chorea (extrapyrimidal symptom)
- ex. Huntington's chorea (due to atrophy of the caudate nucleus in the BG), Sydenham's chorea (rheumatic fever)
This type of muscle contractions are prolonged sustained contraction/rigidity.
Tonic (extrapyrimidal symptom)
This type of muscle contractions are repetitive rapid movements.
Clonic (extrapyrimidal symptom)
This type of tremor occurs while holding position against gravity.
Postural tremor (extrapyrimidal symptom)
This type of tremor occurs during movement or when approaching nearer to a target.
Intentional tremor (extrapyrimidal symptom)
___________ disorders are associated with tremor, bradykinesia, rigidity, and postural instability.
Multiple sclerosis is an ____1____ & ____2_____ disease of the CNS (idiopathic). It is associated with axon degeneration of white matter of the ___3___, ___4___, &___5___.
- 1. autoimmune
- 2. inflammatory
- 3. brain
- 4. optic nerve
- 5. spinal cord
One must suspect _______ in young patients with trigeminal neuralgia.
This clinical manifestation of MS involves worsening of symptoms with heat (ex. exercise, fever, hot tubs).
___________ presents with unilateral eye pain worse with eye movements, diplopia, central scotomas, vision loss (especially color).
Optic neuritis (retrobulbar)
Marcus-Gunn pupil occurs while performing swinging flashlight test from the (unaffected/affected) ___1___ eye to the (unaffected/affected) ___2___ eye, the pupils appear to (dilate/constrict) ___3___.
- 1. unaffected
- 2. affected
- 3. dilate
- - due to less than normal pupillary constriction.
- - due to the brain perceiving the delayed conduction of affected optic nerve as if light was reduced.
What is the first-line treatment for acute exacerbations of MS?
IV corticosteroids (high dose)
- immunomodulators: cyclophosphamide
- plasmapharesis if unresponsive to corticosteroids.
___________ is the treatment for fatigue related to MS.
__________ is the test of choice for confirming the diagnosis of MS.
MRI with gadolinium
What is/are the medications used to decrease the #/severity of relapses in relapsing-remitting/progressive MS?
- 1. β-interferon*
- 2. Glatiramer acetate (Copaxone)