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Components of the circle of Willis
Vertebrals (become basilar), posterior cerebrals, posterior communicating, anterior cerebrals, anterior communicating
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Efficient collateral circulation of brain
Circle of willis
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Nerve injury with temporary loss of function
Neurapraxia
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Disruption of axon with preservation of axon sheath
Axonotmesis
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Disruption of axon and axon sheath, may need surgery
Neurotmesis
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Rate of nerve regeneration
1mm/day
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bare sections of nerves, allow salutatory conduction
nodes of Ranvier
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hormone released in response to high plasma osmolarity, causing increased water absorption in collecting ducts
ADH
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Lack of ADH causing inc urine output, dec urine specific gravity, inc serum Na and osmolality
Diabetes insipidus
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Treatment of Diabetes insipidus
DDAVP, free water
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Inappropriate ADH release causing dec urine output, concentrated urine, dec serum Na and osmolality
SIADH
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Treatment of SIADH
Fluid restriction, diuresis
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Most common presentation of intracranial AVMs
Hemorrhage
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Treatment of intracranial AVMs
Coil embolization then resection
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Pathology occurring most often near branch points in artery, present with bleeding, mass effect, seizures or infarcts
Cerebral aneurysm
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Treatment of cerebral aneurysm
Coil embolization then resection (if elective)
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Torn bridging veins causing bleeding
Subdural hematoma
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Injury to middle meningeal artery; lucid interval followed by LOC
Epidural hematoma
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Bleeding caused by AVMs and cerebral aneurysm
Subarachnoid hemorrhage
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Symptoms of SAH
Stiff neck, severe headache, photophobia
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Treatment of SAH
Hypervolemia, calcium channel blockers
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Lobe most commonly affected by intracerebral hematomas
Temporal lobe
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treatments of elevated ICP
elevate HOB, sedation, paralytic, moderate hyperventilation, mannitol, craniectomy
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symptoms of inc ICP
stupor, headache, nausea/vomiting, stiff neck
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signs of inc ICP
HTN, HR lability, slow respirations (Cushing�s triad)
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Injury causing areflexia, flaccidity, anesthesia, and autonomic paralysis below the level of the lesion
Complete cord transection
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Hypotension, normal or slow HR, warm extremities occurring with spinal cord injury above T5
Spinal shock
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Treatment of spinal shock
Phenylephrine
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Bilateral loss of motor, pain and temperature sensation below level of lesion with preservation of position-vibratory sense and light touch
Anterior spinal artery syndrome
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Loss of ipsilateral motor, contralateral pain, and temperature
Brown-sequard syndrome, or incomplete cord transection
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Bilateral loss of motor, pain and temperature sensation in upper extremities with lower extremity sparing
Central cord syndrome
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Pain and weakness in lower extremities due to compression of lumbar nerve roots
Cauda equina syndrome
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Tract carrying pain and temp sensory neurons
Spinothalamic tract
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Tract carrying motor neurons (2)
Corticospinal tract, rubrospinal tract
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Nerve roots carrying sensory fibers (typically afferent)
Dorsal nerve roots
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Nerve roots carrying motor neuron fibers (typically efferent)
Ventral nerve roots
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Symptoms of brain tumors
Headache, seizures, progressive neuro defect, persistent vomiting
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Adult brain tumors: more supratentorial or infratentorial?
2/3 supretentorial
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childhood brain tumors: more supratentorial or infratentorial?
2/3 infratentorial
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most common primary brain tumor
glioma
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most common site of brain tumor metastasis
lung
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most common brain tumor in children
medulloblastoma
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most common brain mets in children
neuroblastoma
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most common spine tumor
neurofibroma (benign)
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intradural tumors: more often benign or malignant?
Benign
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Extradural tumors: more often benign or malignant?
Malignant
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Complication seen in premature infants secondary to rupture of fragile vessels in germinal matrix
Intraventricular hemorrhage
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Symptoms of intraventricular hemorrhage
Bulging fontanelle, neurologic defects, dec BP, dec Hct
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Herniation of spinal cord and nerve roots through a defect in vertebra
Myelomeningocele
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Area of brain for speech comprehension
Wernicke�s area (temporal lobe)
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Area of brain for speech motor
Broca�s area (posterior part of anterior lobe)
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Complication of XRT of pituitary adenoma
Pituitary apoplexy
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Nerves that innervate diaphragm
Cervical nerve roots 3-5
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Brain macrophages
Microglial cells
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Cranial nerve for smell
CN I (olfactory)
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Cranial nerve for sight
CN II (optic)
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Cranial nerve for motor to eye
CN III (oculomotor)
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Cranial nerve for superior oblique motor
CN IV (trochlear)
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Cranial nerve for sensory to face and mastication muscles
CN V (trigeminal)
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Cranial nerve for motor to lateral rectus
CN VI (abducens)
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Cranial nerve for taste to anterior 2/3 of tongue and motor to face
CN VII (facial)
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Cranial nerve for hearing
CN VIII (vestibulocochlear)
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Cranial nerve for taste to posterior 1/3 of tongue and swallowing muscles
CN IX (glossopharyngeal)
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Cranial nerve for many parasympathetic actions, including gut-related
CN X (vagus)
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Cranial nerve for motor to trapezius and SCM
CN XI (spinal accessory)
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Cranial nerve for motor to tongue
CN XII (hypoglossal)
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