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Where is the lesion to create a locked in syndrome that preserves vertical eye movement?
Base of the pons
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What structures are taken out in a complete Wallenbergs (Lateral medullary syndrome)?
What symptoms does this cause?
- 5 - Trigeminal nucleus - sensory loss to ipsilateral face
- 8 - Vestibular nuclei - vertigo, nystagmus, nausea and vom
- 9 - Glossopharyngeal - Decreased gag reflex
- 10- Vagus - Ipsilateral paralysis of palate and vocal cord, hoarseness and dysphagia
- Spinothalamic tract - causing pain and temp loss on contralateral side of face
- Sympathetic tract - causing ipsilateral horners
- Cerebellum - ipsilateral ataxia
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Which artery is affected if youve got a Wallenbergs + hearing loss?
AICA
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Amyloid beta related angiitis?
- Rare type of CNS vasculitis that complicates CAA.
- Headaches, seizures, cognitive changes, focal neurological deficits
- CSF shoes Raised protein and mild Lymphocytosis.
- Imaging shows leptomeningeal enhancement, white matter change, infarcts, haemorrhages and cortical haemosidirin deposition.
- Treat with steroids and immunosuppression (cyclophos) like you would with vasculitis.
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Sudden onset Abulia?
- Lack of motivation – often comes with confusion.
- Infarct of the right caudate
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Absolute contraindications for thrombolysis?
- Platelet count<100
- SBP>185
- DPB>110
- BM<2.7
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Nosebleeds and lip telangiectasia?
- They’ll get strokes and cerebral abscesses cuz of pulmonary AVMS.
- Close the pulmonary AVMs
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Marfanoid habitus with learning difficulties?
- Homcystinuria
- They’ll get CVST due to VTE predisposition
- Cystathionine Beta-synthase defective.
- Give Vit B6 (pyridoxine), folate and B12
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Strctures within the Cavernous Sinus mnemonic?
- Oculomotor
- Trigeminal
- Opthalmic
- Maxillary
- Carotid
- Abducens
- Trochlear
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One and a half syndrome
- No horizontal movements on ipsilateral side of lesion Only abduct on contralateral side
- Lesion is affecting abducens nerve and MLF (which speaks to the oculomotor)
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Weber’s syndrome?
Ipsilateral 3rd with contralateral hemiparesis due to a lesion in the midbrain affecting the 3rd nerve fibres and cerebral peduncle
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Which cells provide the majority of the input to the cerebellum?
- MINimum input via one peduncle (mossy in)
- Mossy fibres via the inferior peduncle ONLY
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Which cells provide majority of output from the cerebellum?
- Maximum POUT (purkinje out)
- Purkinje fibres
- Via the superior and middle peduncles
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How do you remember the deep cerebellar nuclei?
- From lateral to medial
- Dogs eat good food
- Dentate
- Emboliform
- Globose
- Fastigial
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Mollaret’s triangle?
- Dentatorubroolivary tract
- Dentate - lateral cerebellum
- red nucleus
- Olives in the ventrolateral thalamus
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Blood supply of the internal capsule?
Anterior choroidal artery - direct branch from the ICA
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Blood supply of the caudate?
Recurrent artery of Huebner - Branch of the ACA.
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The circuit of Papez?
- HMACE
- Hippocampus
- Mamilary bodies
- Anterior thalamus
- Cingulate gyrus
- Entorhinal cortex
Or
Elephants Have Fantastic (fornix) Memories And Cocks
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Which part of the spinal cord is most vulnerable to ischaemia?
Upper thoracic T1-4
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Where do the dorsal columns take information to?
The VPL nucleus of the thalamus
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Which arteries supply the spinal cord?
- Anterior spinal artery coming off the vertebral.
- The great artery of Adamkiewicz - off the thoracic aorta
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A laterally compressing lesion will take out which tract first?
Spinocerebellar
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What is the relevance of the spot sign in regard to spontaneous ICH?
It is the presence of visible contrast within the bleed (often serpiginous or linear) and indicates that a bigger bleed is about to happen.
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Which locations are commonest for microhaemorrhages in HTN?
- Basal ganglia
- Thalamus
- pons
- cerebellum
In that order
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Tightly controlling their blood glucose does what for diabetics?
- Controls their microvascular complications but does not do much for the macrovascular.
- Control the HTN for that
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Whats the most common sort of bleed caused by an AVM?
Intraparenchymal
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What do you do for intracranial stenoses?
- Antiplatelet only.
- WAFID said warfarin was no better.
- SAMMPRIS said stenting had more adverse events.
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Perimesencephalic Subarachnoid Haemorrhages are secondary to what?
- Nothing! most of the time theres no underlying cause!
- Occasionally its because of Basilar artery dissection, AVM or Vasospasm.
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What is Sneddons syndrome
- Livedo reticularis
- TIAs and strokes
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What’s the first test to do in a kid with a port-wine stain?
Full ophthalmic review to look for angioma’s in the eye that could cause glaucoma – prevent them going blind
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What is the monoamine synthesis pathway?
- Tyrosine
- DOPA
- Dopamine
- Noradrenaline
- Adrenaline
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Where does a Weber's syndrome localise to and which aretery needs to be occluded?
- Cerebral peduncles.
- Branches of the PCA or top of the basilar
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What did CREST tell us about adverse effects of CEA vs CAS?
- CEA = increased risk of MIs
- CAS = Increased risk of strokes
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What is the hourly rate of CSF production from the choroid plexus?
20mls/hr
-
GABAA receptors are ligand gated chloride channels, but what are GABAB?
Metabotropic receptors that cause an efflux of potassium to hyperpolarise the membrane
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Which inferior cerebellar artery and which lateral syndrome?
- AICA = Lateral pontine syndrome
- PICA = Lateral medullary syndrome
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Management of PFOs?
- If evidence of a DVT - close PFO
- If no evidence - antiplatelets only
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If the history and scan scream CADASIL but the NOTCH3 is negative, which conditions should you think of?
- CARASIL - HTRA1 mutation
- Fabrys - GLA mutation - leads to a-galactosidase deficit
- MELAS - MT-TL1 mutation
- TREX1 - CADASIL hx + retinal vasculopath
- COL4A1
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Familial cerebral cavernous malformations are caused by which gene mutations?
KRIT1 (CCM1)
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What clinical feature sets CARASIL apart from CADASIL?
Alopecia
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What cell types in the cerebrum and cerebellum are susceptible to hypoxia?
- Pyramidal cells in CA1
- Neurone layer 3, 5 and 6 in the cortex
- Purkinje cells
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Why dont we like L-Asparginase?
- It causes Antithrombin, Prot c and S deficiency.
- Causes CVST
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Why is methotrexate, cyclophosphamide and 5FU bad for your clotting?
Causes an acquired Prot C deficiency and encourages clots.
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What medication can help in homocystinuria?
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Embryological origins of the Neuraxis?
- Pros, Mes, Rhom - prostitutes messy rooms
- Pros - Tel and Di
- Mes - midbrain
- Rhom - Met and Myel
- Tel - Cerbral cortex, Putamen and caudate
- Di - GP, Thalamus, STN, Sub.nig, Hypothalamus,
- Met - Pons and cerebellum
- Myel - medulla
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Commonest cause of lobar haemorrhage?
HTN
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How long does it take for the activity of neurons to stop after an interruption to blood flow?
4-6mins
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Which neurotransmitter is associated with REM sleep?
Acetylcholine
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Nuclei of the transverse section of spinal cord?
- Substantia gelatinosa - Pain and temp
- Nucleus proprius - VPL
- Dorsal nucleus of Clarke - JPS
- Intermediate nuclei - Autonomics
- Motor nuclei - Motor
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What is normal blood flow to the brain in ml/100g/min?
50
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What is penumbral blood flow?
- 8-18 ml/100mg/min
- Below this you get cell death
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Porphyria DOES NOT commonly present with strokes. What does it present with?
- Abdominal pain
- Cold-induced neuropathy
- Mania and confusion
- Anaemia
- Seizures
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What haematological effects does B12 deficiency cause?
- Macrocytic anaemia
- Hypercoagulabilty due to hyperhomocysteinemia
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