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Alzheimer's disease (AD):

Alzheimer's disease (AD): associations, findings
AD:
   *Associations:
  • Aluminum toxicity
  • Acetylcholine deficiencies
  • Amyloid B
  • Apolipoprotein gene E
  • Altered nucleus basalis of Meynert
  • Down's
       *Findings:
  • Actin inclusions (Hirano bodies)
  • Atrophy of brain
  • Amyloid plaques
  • Aphasia, Apraxia, Agitation
  • DNA-coiled tangles
  • Dementia, Disoriented, Depressed
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Alzheimer's disease: common characteristics
ALZHEIMER'S:
  • Anterograde amnesia is usually first sign
  • Life expectancy increase shows more cases in recent years
  • Zapped (loss of) acetylcholinergic neurons
  • Hereditary disease
  • Entire hippocampus becomes affected
  • Identified by neurofibrillary tangles
  • Mutation in amyloid genes associated w/ disease
  • Entorhinal areas degenerate first
  • Retrograde amnesia ultimaltely develops
  • Senile plaques are formed at synapse
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Argyll-Robertson Pupil: features
  • Argyll Robertson Pupil (ARP)
  • Read it from front to back: it is ARP, standing for Accomodation Reflex Present.
  • Read it from back to front: it is PRA, standing for Pupillary Reflex Absent.
Argyll-Robertson Pupil: features
  • Argyll Robertson Pupil is like a prostitute.
  • She/he will accomodate, but will not react.
  *Pupil still accomodates, but doesn't react to light.
  *Pupil is a common sign in syphilis, which is often carried by prostitutes.
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Auditory pathway: mandatory stops
"Come In My Baritone":
  • Cochlear nucleus
  • Inferior colliculus
  • Medial geniculate nucleus
  • Brodmann's 41 (cortex)
Babinski and LMN signs: conditions exhibiting them
"D MASTS":
  • Diabetes
  • Motor neuron disease
  • Ataxia (friedrichs)
  • Subacute combined degeneration of cord
  • Tabo paresis
  • Syringobulbia
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Balint's syndrome
SOOT:
  • Simultagnosia
  • Optic ataxia
  • Ocular apraxia
  • Tunnel vision
Basal ganglia: D1 vs. D2 connections
  • D1 has 1 connection (Striatum-GPi/SNpr).
  • D2 has 2 connections (Striatum-GPe-GPi/SNpr).
Basal ganglia: indirect vs. direct pathway
  • The Indirect pathway Inhibits.
  • Direct pathway is hence the excitatory one.
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Battle sign
  • BattlE:
  • Behind Ear
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Bell's palsy: symptoms
BELL'S Palsy:
  • Blink reflex abnormal
  • Earache
  • Lacrimation [deficient, excess]
  • Loss of taste
  • Sudden onset
  • Palsy of VII nerve muscles
 All symptoms are unilateral.
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Benidict's syndrome: site affected
  • Benidict's test for sugar gives red precipitate.
  • Similarly, Benidict's syndrome affects red nucleus.
Image result for benedikt syndrome
Branchial arches: cranial nerve innervation
In Sensory/Motor/Both mnemonic 'Some Say Marry Money But My Brother Says
Big Boobs Matter More', the B's also give Brancial arch
nerves in order:
  • But (CN 5): 1st arch
  • Brother (CN7): 2nd arch
  • Big (CN9): 3rd arch
  • Boobs (CN 10): 4th arch
Broca's vs. Wernick's area: effect of damage to speech center
  • "Broca": your speech machinery is Broken. Broca is wanting to speak, but articulation doesn't work, and very slow.
  • "Wer-nick": "were" and "nick" are both words of English language, but together they are nonsensical.  *Wernick is having good articulation, but saying words that don't make sense together.
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Cerebellar deep nuclei
"Ladies Demand Exceptional Generosity From Men":
The 4 nuclei, from lateral to medial:
      *[Lateral]
  • Dentate
  • Emboliform
  • Globose
  • Fastigial
      *[Medial]
   *Alternatively,
"Fat Girls Eat Doughnuts":
 From medial to lateral:
  • Fastigial
  • Globose
  • Emboliform
  • Dentate
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Cerebellar damage: symptoms
VANISHeD:
  • Vertigo
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonic reflexes
  • Dysdiadochokinesia.
Cerebellar: functional areas
Anatomical shape/location of cerebellar areas is a key to their function and related tract.
Vermis = Spinocerebellar = Axial equilibrium.
  Vermis: right down the axis of cerebellum, and vertically segmented like a spinal column.Flocculonodular lobe = Vestibulocerebellar = Ear, eye, body coordination.
Flocculonodular lobe: flares out to the edges, just like ears.
Hemispheres of cerebellum = Cerebrocerebellar = Peripheral coordination.
Hemispheres: around periphery of cerebellum, and tract to cerebral hemispheres.
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Cerebral palsy: general features
PALSY:
  • Paresis
  • Ataxia
  • Lagging motor development
  • Spasticity
  • Young
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Cerebellar peduncles: afferent vs efferent
SEMA:
  • Superior cerebellar peduncle
  • Efferent (fibres)
  • Middle cerebellar peduncle
  • Afferent (fibres)
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Chemoreceptor trigger zone
"Syringes Help Men On Drugs":
  • Serotonin
  • Histamine
  • Muscarinic
  • Opioids
  • Dopamine
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Chorea: common causes
Some VITUS'S  DANCE:
  • Sydenhams
  • Vascular
  • Increased RBC's (polycythemia)
  • Toxins: CO, Mg, Hg
  • Uremia
  • SLE
  • Senile chorea
  • Drugs
  • APLA syndrome
  • Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA
  • Conception related: pregnancy, OCP's
  • Endocrine: hyperthyroidism, hypo-, hyperglycemia
Image result for chorea movementImage result for chorea movement
Coma causes checklist
AEIOU TIPS:
  • Acidosis/ Alcohol
  • Epilepsy
  • Infection
  • Overdosed
  • Uremia
  • Trauma to head
  • Insulin: too little or or too much
  • Pyschosis episode
  • Stroke occurred
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COMA: Coma and signicantly reduced conscious state causes
COMA
  • CO2 and CO excess
  • Overdose: TCAs, Benzos, EtOH, insulin, paracetamol, etc.
  • Metabolic: BSL, Na+, K+, Mg2+, urea, ammonia, etc.
  • Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc.
Coma: conditions to exclude as cause
MIDAS:
  • Meningitis
  • Intoxication
  • Diabetes
  • Air (respiratory failure)
  • Subdural/ Subarachnoid hemorrhage
Coma: differential
UNCONSCIOUS:
  • Units of insulin
  • Narcotics
  • Convulsions
  • Oxygen
  • Nonorganic
  • Stroke
  • Cocktail
  • ICP
  • Organism
  • Urea
  • Shock
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Congenital myopathy: features
DREAMS:
  • Dominantly inherited, mostly
  • Reflexes decreased
  • Enzymes normal
  • Apathetic floppy baby
  • Milestones delayed
  • Skeletal abnormalities
Image result for congenital myopathyImage result for congenital myopathy
Coronal section of brain: structures
"In Extreme Conditions Eat People's Guts Instead of Their Hearts":
   From insula to midline:
  • Insula
  • Extreme capsule
  • Claustrum
  • External capsule
  • Putamen
  • Globis pallidus
  • Internal capsule
  • Thalamus
  • Hypothalamus
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Cranial nerves
"One Of Our Trained Teachers Asked For A Good, Vibrant And Hardworking Student ":
  • Olfactory
  • Optic
  • Occulomotor
  • Trochlear
  • Trigeminal
  • Abducens
  • Facial
  • Auditory
  • Glossopharyngeal
  • Vagus
  • Accessory
  • Hypoglossal
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Cranial nerves: olfactory and optic numbers
"You have two eyes and one nose":
  • Optic nerve is cranial nerve two.
  • Olfactory nerve is cranial nerve one.
 Alternatively, note alphabetical order: oLfactory, and oPtic.
Image result for olfactory and optic nerves
Cranial nerves: sensory, motor or both
"Some Say Marry Money But My Brother Says Big Brains Matter More":
 From I to XII:
  • Sensory
  • Sensory
  • Motor
  • Motor
  • Both
  • Motor
  • Both
  • Sensory
  • Both
  • Both
  • Motor
  • Motor
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CSF circulation: function of choroid vs. arachnoid granules
  • Choroid Creates CSF.
  • Arachnoid granules Absorb CSF.
Image result for choroid and arachnoid granulesImage result for meningeal layers
Dandy-Walker syndrome: components
"Dandy Walker Syndrome":
  • Dilated 4th ventricle
  • Water on the brain
  • Small vermis
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Dementia: reversible dementia causes
DEMENTIA:
  • Drugs/ Depression
  • Elderly
  • Multi-infarct/ Medication
  • Environmental
  • Nutritional
  • Toxins
  • Ischemia
  • Alcohol
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Dementia: some common causes
DEMENTIA:
  • Diabetes
  • Ethanol
  • Medication
  • Environmental (eg CO poisoning)
  • Nutritional
  • Trauma
  • Infection
  • Alzheimer's
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Dementia: treatable causes
DEMENTIA:
  • Drug toxicity
  • Emotional (depression, anxiety, OCD, etc.)
  • Metabolic (electrolytes, liver dz, kidney dz, COPD)
  • Eyes/ Ears (peripheral sensory restrictions)
  • Nutrition (vitamin, iron deficiencies/ NPH [Normal Pressure Hydrocephalus]
  • Tumors/ Trauma (including chronic subdural hematoma)
  • Infection (meningitis, encephalitis, pneumonia, syphilis)
  • Arteriosclerosis and other vascular disease
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Dorsal= afferent, Ventral= efferent and their functions
"My friend DAVE got kicked in the behind and screamed":
  • Dorsal/Afferent component is the sensation of pain coming from the rear.
  • Ventral/Efferent component is the motor action of screaming (which is done at front of body).
Dysphagia vs. dysphasia
  • DysphaSia is for Speech
  • DysphaGia is for your Gut [swallowing].
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Encephalitis: differential
HE'S LATIN AMERICAN:
  • Herpesviridae
  • Enteroviridae (esp. Polio)
  • Slow viruses (esp. JC, prions)
  • Syphilis
  • Legionella/ Lyme disease/ Lymphocytic meningoencephalitis
  • Aspergillus
  • Toxoplasmosis
  • Intracranial pressure
  • Neisseria meningitidis
  • Arboviridae
  • Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor
  • E. coli
  • Rabies/ Rubella
  • Idiopathic
  • Cryptococcus/ Candida
  • Abscess
  • Neoplasm/ Neurocysticercosis
  *Neurocysticercosis should be assumed with recent Latin American immigrant patient unless proven otherwise.
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Epilepsy: types, drugs of choice
"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies":
  • Myoclonic
  • Grand mal
  • Atonic
  • West syndrome
  • Focal
  • Petit mal (absence)
  Respective drugsy:
  • Valproate
  • Valproate
  • Valproate
  • ACTH
  • Carbamazepine
  • Ethosuximide
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Foramen ovale: contents
OVALE:
  • Otic ganglion (just inferior)
  • V3 cranial nerve
  • Accessory meningeal artery
  • Lesser petrosal nerve
  • Emissary veins
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GABA vs. Glu: the excitatory vs. inhibitory transmitter in brain (eg in basal ganglia)
  • When you Glue two things together, you add (+) those things together, therefore Glu is the excitatory one (+).
  • GABA is therefore the negative one.
Image result for GABA
Geniculate bodies: medial vs. lateral system
MALE:
Medial=Auditory. Lateral=Eye.
  • Medial geniculate body is for auditory system, lateral geniculate body is for visual system.
  • Can expand to MALES to remember Lateral=Eye=Superior colliculus (thus medial is inferior colliculus by default).
Image result for medial and lateral geniculate body
Geniculate bodies: paired to respective colliculi
SLIM:
  • Superior colliculi: Lateral geniculate body.
  • Inferior colliculi: Medial geniculate body.
Image result for superior colliculus
Geniculocalcarine tract:
Lower bank of calcarine sulcus is the Lingual gyrus: it receives input from Lower retinal quadrants.
Therefore, Cuneus is the Upper bank of calcarine sulcus: it receives input from Upper retinal quadrants.
  Remember: lower retinal quadrants represent superior visual field quadrants and viceversa.
Image result for geniculocalcarine tract
Head trauma: rapid neuro exam
12 P's:
  • Psychological (mental) status
  • Pupils: size, symmetry, reaction
  • Paired ocular movememts
  • Papilloedema
  • Pressure (BP, increased ICP)
  • Pulse and rate
  • Paralysis, Paresis
  • Pyramidal signs
  • Pin prick sensory response
  • Pee (incontinent)
  • Patellar relex (and others)
  • Ptosis
  *Reevaluate patient every 8 hrs.
Image result for head trauma
Huntington's: chromosome, involvement
HUNT 4 DATE:
  • HUNTington's on chromosome 4, with cauDATE nucleus involvement.
Image result for huntington's disease symptoms
Hypothalamus: feeding vs.satiety center
"Late night snack":
  • LATEral is snacking [feeding] center. Therefore, ventromedial is satiety center.
Image result for satiety center
Hypothalamus: general functions
"TALE of the hypothalamus":
  • Temperature
  • Appetite
  • Libido
  • Emotion
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ICU: confusion causes
ICU CONFUSION:
  • ICU psychosis
  • Cardiac output low [hypotension, post cardiac arrest]
  • Uncontrolled temperature [hypo/hyperthermia]
  • Convulsion [post ictal]
  • Oxygen [hypoxia, hypercarbia]
  • Nociception [pain]
  • Full bladder
  • Uremia
  • Sugar [hypo/hyperglycemia]
  • Infection
  • Opiates
  • Natremia [hypo/hyper]
Image result for icu confusion
Lower vs. upper motor neuron lesion effects
1. "STORM, Baby"
2. 'In a Lower motor neuron lesion, everything goes Down:
   STORM Baby tells you effects:
  • Strength
  • Tone
  • Other
  • Reflexes
  • Muscle mass
  • Babinski's sign
  *In Lower all things go down: strength, tone, reflexes, muscle mass, and the big toe down in plantar reflex (Babinski's sign is big toe up: toe up = UMNL)
Alzheimer's disease (AD): Alzheimer's disease (AD): Reviewed by Bright Zoom on May 06, 2018 Rating: 5

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