Pathology

Parkinson's Disease

Myasthenia Gravis

Chemo Effects on Nervous

System

Alcohol Effects on Purkinje

Neurons

Charcot Marie Tooth Disease

Multiple Sclerosis

Sensory Pain Axons in

Periphery
Subarachnoid Hemorrhage

Spinal Meningitis

Hydrocephalus
Damage to Cranial Nerve 1
Damage to Cranial Nerve 2

Damage to Cranial Nerve 3,

4, 6

Damage to Cranial Nerve 5

Damage to Cranial Nerve 7
Damage to Cranial Nerve 8

Damage to Cranial Nerve 9

Damage to Cranial Nerve 10

Damage to Cranial Nerve 11

Damage to Cranial Nerve 12

Spina Bifida

Anencephaly

Neurocristopathies

Ptosis

Bell's Palsy
Bell's Palsy

Cutting of the Facial Nerve

Danger Zone of the Face

Scalping

Danger Zone of the Scalp

Acromegaly
Acromegaly

Cushing Syndrome

Congenital Insensitivity to
Pain with Anhidrosis
Amyotropic Lateral Sclerosis

Huntington Disease

Alzheimer Disease
Alzheimer Disease

Parkinson Disease

Peripheral Neuropathy
When Trophic Factors Go BAD

Craniosynostosis

Le Fort Fractures

Epidural Hemorrhages
Subdural Hemorrhages

Subarachnoid Hemorrhages

Tentorial Hernia

Whiplash
Hangman's Fracture

Nociceptive Pain

Neuropathic Pain

Mixed Pain

Idiopathic Pain

Allodynia

Hyperalgesia (peripheral and

central, primary and
secondary)

Referred Pain
Radicular Pain

Lesions of Corticospinal, ALS,

DCML Systems
Symptoms

Loss of substantia nigra in the midbrain leads to loss of control of motor movements. Neuromelanin, a
byproduct of dopamine synthesis, is found both in the substantia nigra and the locus coerculus

An autoimmune disease with antibodies targeted to the Ach receptor on the post synaptic cell. Muscle
weakness, ptosis

Microtubules play a large role in the nervous system due to the near constant need for transporting pr
neurotransmitters, and vesicles up and down axons. Some chemotherapies include microtubule inhibi
These can cause peripheral neuropathy due to the loss of vesicle transport along the axon

Purkinje neurons have the largest dendritic field in the brain. Increased dendrites and dendritic spines
increased synaptic input received. They are located in the cerebellum and control motor movements.
inhibits these neurons, leading to stumbling and falling

Mutation in the PMP22 protein found in Schwann cells that myelinate peripheral axons

Autoimmune attack on oligodendrocytes that myelinate axons in the central nervous system. Women,
commonly present with a "blind spot" in vision since optic nerve is commonly demyelinated

Pain axons are NOT myelinated, so pain travels slowly up and down the axon, leading to a slow ache/t

Hemorrhage of a blood vessel within the arachnoid mater

CSF is relatively acellular. If inflammatory cells are found with the appropriate symptoms (terrible hea
fever, meningeal signs, etc.), could point to meningitis
Blockage of drainage of CSF leads to high pressures of CSF and potential brain damage
Anosmia- loss of ability to smell
Visual field deficits. Depends strongly on localization of lesion

3-oculomotor- pupil constantly dilated, eye looking down and laterally, cannot move eyelid upwards

4-trochlear- head tilt since eye cannot look down and lateral

6-abducens-inability to look from side to side since eye cannot move laterally

Trigeminal- facial weakness, inability/difficulty chewing

Facial- facial weakness, loss of taste in anterior 2/3 of tongue, loss of salivary/lacrimal gland secretion
Vestibulocochlear- deafness or balance disorder
Glossopharyngeal- hoarse, hard to swallow and speak, dry mouth, loss of taste in posterior 1/3 of tong
numbness in mouth
Vagus- loss of gland secretions in visceral organs, increased HR, dry mouth, loss of gag reflex, hoarse,
swallow
Spinal accessory nerve- inability to move head or shrug

Hypoglossal- abnormal tongue protrusions

1 in 1000 births, failure of the caudal neuropore to close. Meningocele- just fluid and meninges.
Myelomeningocele- fluid, meninges, and spinal cord. Occulta- just tuft of hair.

Failure of the rostral neuropore to close

Refers to a large group of disorders that come from derivatives of neural crest, ex- Schwann cells, mel
odontoblasts, Meckel cell, dorsal root ganglia, sympathetic/parasympathetic/enteric ganglia, chromaffi
adrenal medulla

Indicative of oculomotor nerve damage, cannot open the eye fully, part of Horner syndrome

Idiopathic (HSV isolated 80% of the time) paralysis of facial muscles, innervated by the facial nerve. A
side droops and sags, inability to close eye, inability to close mouth. Drooling, tearing.
Idiopathic (HSV isolated 80% of the time) paralysis of facial muscles, innervated by the facial nerve. A
side droops and sags, inability to close eye, inability to close mouth. Drooling, tearing.

If the laceration is MEDIAL to the lateral canthus of the eye, the nerve will eventually reinnervate. If th
laceration is LATERAL to the lateral canthus, requires re-anastomosis of the nerve endings to acquire
reinnervation

In between the eyes and nose is referred to as the "danger zone" since these areas drain to the facial
which has anastomoses to the cavernous sinus via ophthalmic veins. This means that bacteria from a
can end up dangerously close to the brain

Usually involves pulling of the hair, skin, connective tissue, and epicranial aponeurosis. Loose connect
layer gives way, leaving the periosteum of the skull exposed. This can lead to heavy bleeding since th
of the scalp do not contract, and the epicranial aponeurosis pulls frontalis and occipitalis muscles awa
each other

The 4th layer (Loose connective tissue) is deemed the "danger zone" since its veins drain back to the
vein, which has anastomoses to the cavernous sinus via the ophthalmic veins. This one way flow of bl
easily change direction in pathology. Also, the arteries do not contract well in bleeding

Increased growth hormone causes frontal bossing and enlargement of soft tissue structures, like ear a
Increased prominence of forehead, nose, and jaw, overall coarsened facial features
Increased growth hormone causes frontal bossing and enlargement of soft tissue structures, like ear a
Increased prominence of forehead, nose, and jaw, overall coarsened facial features

Increased adrenal hormone cortisol causes "moon face", red cheeks, and hirsutism

4th type of hereditary and sensory neuropathy leading to a complete absence of pain and thermal sen
as well as a lack of sympathetic and internal regulation. Leads to mental retardation and learning issu
function is normal. Painless injuries lead to chronic infections, can suffer from both hypo and hyperthe
Bilateral Horner syndrome (ptosis, miosis- constricted pupil, anhidrosis).

Loss of function mutation in TrkA, which binds NFP, leading to neuron support
Degeneration of cortical, bulbar, and spinal motor neurons leads to muscle weakness, atrophy, loss of
speak or swallow. Eventually die of respiratory paralysis and failure.

Autosomal dominant mutation in huntingtin. Involuntary writhing, chorea, cognitive decline, dementia

Loss of cholinergic neurons, leading to dementia and cognitive impairments. Phosphorylation of tau le
build up of misfolded beta amyloid
Loss of cholinergic neurons, leading to dementia and cognitive impairments. Phosphorylation of tau le
build up of misfolded beta amyloid

Degeneration of dopaminergic neurons leads to resting tremor, muscle rigidity, bradykinesia

Damage affecting peripheral nerves, interferes with sensation, movement, and gland and organ funct

Osteoarthritis, lower back pain, interstitial cystitis, pancreatitis. Inflammation leads to increased growt
Osteoarthritis, lower back pain, interstitial cystitis, pancreatitis. Inflammation leads to increased growt
and cytokines

Premature closure of sutures within the skull.

Scaphocephaly- premature closure of sagittal fissure

Oxycephaly/turricephaly- premature closure of coronal suture

LeFort 1- upper teeth separated from face

LeFort 2- upper teeth and nose separated from face

LeFort 3- upper teeth, nose, lower orbit separated from face

Blood collection between bone and dura. Usually due to tear of middle meningeal artery
Blood collects between dura and arachnoid

Blood in CSF. Blood collects in subarachnoid space, between arachnoid and pia. Stiff neck, headache,
consciousness. Usually due to HTN, which leads to paralytic stroke

Herniation of the temporal lobe of the brain through the tentorium cerebelli due to increased pressure
the fold (epi or subdural hemorrhage) or decreased pressure below the fold (CSF leaking from spinal c
Leads to compression of oculomotor nerve (eye cannot open, looks down and laterally), shift of structu
retained Babinski sign

Excessive hyperextension/flexion of anterior longitudinal ligament and anterior neck muscles. Pain
Fracture of the posterior aspect of the axis

Pain with a physiologic, protective function. Example- putting hand on stove and pulling it away. The p
proportional to the intensity of stimulation of the nociceptor. Can become chronic when association wi
protective function is lost
Pain that does not serve a protective function, disproportional to intensity of the stimulus. Aberrant, e
causing action potentials are comparable to seizure activity
Has both components of nociceptive and neuropathic pain, example- failed lower back surgery
Pain in the absence of a lesion to cause it despite thorough investigation. Pain is disproportionate to d
clinically discernable injury
Pain produced upon a previously non noxious stimulus, pain curve shifted way to the left

Hyperalgesia is a shift of the pain curve to the left- increased pain to a lower intensity of stimulus. Cel
sequester substances that cause pain, so when they are injured, these substances (such as H+, K+,
prostaglandins) are released and cause ectopic foci to produce action potentials. These action potenti
up to the CNS, but also out to the nerve terminals to cause depolarization and release of neurotransm
(peripherally). When this increases and recruits more neurons to participate, it can cause central hype
within the CNS. Positive feedback-cells release substances that activate mast cells, mast cells secrete
fluid, causing action potential to be created and more release of neurotransmitter for more cell injury

Convergence of visceral and cutaneous sensation, ex- arm hurts when having a heart attack
Pain restricted to a dermatome/area of spinal nerve innervation

Remember decussation points. If the lesion is rostral to the decussation, it will cause contralateral defi
lesion is caudal, it will cause ipsilateral deficits.

Decussations- DCML at medial lemniscus, ALS at anterior white commissure (1-2 spinal levels above
after travelling through Lissauer's tract), Corticospinal in pyramids between medulla and cervical

You could be rostral to one decussation and caudal to another!

Treatment

LDOPA

Acetylcholinesterase inhibitors (pyridostigmine)

None

None

Not mentioned

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Not applicable

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Diagnosed via lumbar puncture

Shunt placement
Not applicable
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Diagnosed by high AFP and ultrasound. Can be prevented by 400 mcg folic acid early in the pregnanc

Fatal

Not mentioned

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Surgical intervention if LATERAL to lateral canthus of eye

No injections in this area, careful of infection here

Stop bleeding through compression, usually the scalp can be sewn back on

Not mentioned

Not mentioned
Not mentioned

Not mentioned

Antibiotics, therapy, patient education, removal of baby teeth to prevent oral injuries. Usually die by a
GDNF and VEGF have been shown to increase locomotion and survival

BDNF in conjunction with SSRIs improve survival

NGF supports cholinergic neurons

NGF supports cholinergic neurons

GDNF and BDNF have shown promise

NGF, NT3, GDNF, neurturin have all shown positive effects in trials. Insulin has neurotrophic effects on

Tanzamab and fulranumab- human monoclonal antibodies to NGF

 Tanzamab and fulranumab- human monoclonal antibodies to NGF

TrkA inhibitors

Leads to predictable cranial deformities

Not mentioned

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Watch patient after lumbar puncture!

Not mentioned
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Analgesic drugs, rehab, therapy, education

Gabapentin (lyrica)

Not mentioned

Not mentioned

Not mentioned

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Not mentioned
Not mentioned

Not mentioned, more to come

Photo

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Pathology

Acute Neuronal Injury

Neuron Reaction to Injury

Pigments in Neurons

Granulovacuolar Change
Hirano Bodies
Neurofibrillary Tangles
Bunina Bodies
Lewy Bodies
Negri Bodies
Astrocytosis
Gemistocytic Astrocytes
Alzheimer Type 2 Astrocytes
Rosenthal Fibers
Astrocytoma
Corpora Amlyacea
Oligodendroglioma
Progressive Multifocal Leukoencephalopathy
Ependymal "Skip Lesions" and Granulations
Ependymomas
Choroid Plexus Pathology
Microglial Nodule/"Star"
Arachnoidal/Meningothelial Cells
Myasthenia Gravis
Jendrassik Maneuver

Clinically Important Deep Tendon/Stretch Reflexes

Hypotonia/Hyporeflexia

Hypertonia/Hyperreflexia

Reflexes after Spinal Injury

Rigidity

Spasicity

Clonus
Babinski Reflex
Periorbital Puffiness
Sty
Chalazion
Conjunctivitis
Facial Nerve Damage to Orbicularis Oculi
Orbital Blow Out Fracture
Exopthalmos

Strabismus

Oculomotor Nerve Lesion

Trochlear Nerve Lesion

Abducens Nerve Injury

Glaucoma

Presbyopia

Papilledema
Venous Nicking

Inferior Alveolar Nerve Block

Dislocated Jaw
Mandibular Tori
Broken Jaw
Ankyloglossia
Gleeking
Circular Breathing
Sleep Apnea and Snoring

Infant Feeding

Uvular Deviation
Segmental Demyelination
Axonal Degeneration

Guillan-Barre Syndrome (Acute Inflammatory Demyelinating

Polyradiculoneuropathy)

Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Lepromatous Leprosy

Diphtheria

Varicella Zoster Virus

Charcot-Marie-Tooth
Diabetic Neuropathy
Neurofibroma
Neurofibromatosis 1

Malignant Peripheral Nerve Sheath Tumor

Schwannoma

Neurofibromatosis 2

Patterns of Deficits

Saturday Night Palsy

Traumatic Neuropathy

Median Neuropathy
C7 Radiculopathy

Diabetic Neuropathy

Cryptogenic Sensory Polyneuropathy

Leprosy
Guillan Barre
Chronic Demyelinating Inflammatory Polyradiculoneuropathy
Mononeuropathy Multiplex
Torticollis

Carotid Sinus Massage

Central Lines

Tumors of Lower Lip

Pyramidal Lobe of Thyroid
Thyroglossal Cyst
Thyroid Ima Artery Implications

Hiccups

Laryngeal Cancer

Epiglottitis

Laryngitis

Emergency Airways

KLM Sounds
Growth Patterns of CNS Tumors

Fibrillary (Diffuse) Astrocytoma

Anaplastic Astrocytoma

Glioblastoma

Primary vs Secondary Glioblastoma

Pilocystic Astrocytoma
Pleomorphic Xanthroastrocytoma

Oligodendroglioma

Ependymoma

Myxopapillary Ependymoma

Ganglioglioma
Central Neurocytoma

Medulloblastoma
Atypical Terato-Rhabdoid Tumor (ATRT)

Lymphoma

Meningioma

Von Hippel Lindau Disease

Metastatic Carcinoma

Meningeal Carcinomatosis

Intervertebral Disc Herniation

Brown-Sequard Syndrome
Neurogenic Bladder
Symptoms

From anoxia, ischemia, hypoglycemia. Leads to cell atrophy, nuclear pyknosis, loss of Nissl
substance. Lose H, retain E! Apoptosis

Axonal reaction- damage to axon leads to cell body swelling

Wallerian degeneration- nerve fibers distal to injury
Transsynaptic degeneration- loss of sensory afferent information leads to atrophy of nerve
cells

Lipofuscin- wear and tear pigment, associated with old age, what makes gray matter gray

Neuromelanin- byproduct of dopamine/catecholamine synthesis, found in substantia nigra and

locus coerulus
Associated with aging and Alzheimer disease. See clear vacuoles within the cytoplasm and
small basophilic granules within
Bright, eosinophilic inclusions in the cell made of actin filaments
Misfolded proteins seen best in Bielchowsky stain. Seen in aging and neurodegenerative
diseases
Seen in motor neuron disease, misfolded protein
Seen in Parkinson's disease. Dense core with pale halo
Seen in Rabies virus infection. Granular appearance of viral inclusions
More specific type of gliosis. Increased GFAP, response to injury via proliferation of astrocytes
Not a pathologic type of astrocyte, just a fat swollen astrocyte indicative of a reaction to some
kind
NOT of injury
associated with Alzheimer disease. Associated with hepatic encephalopathy and other
toxic metabolic
Made diseases.
of heat shock Circular,
protein 27 andNO starcrystallin,
Abeta shaped foot processes
misfolded proteins. Seen in 3 diseases:
chronic gliosis, pilocytotic astrocytoma, and Alexander's disease
Diffuse tumor of astrocytes
Misfolded proteins (HSP and ubiquitin) associated with foot processes of astrocytes making up
the blood brain barrier. NORMAL finding in aging
Tumor of oligodendrocytes, leads to loss of myelination and abnormal myelin formation
JC virus infects oligodendrocytes, leading to demyelination and a huge increase in size of the
oligodendrocyte nucleus
CMV infects the ependymal cells (ciliated columnar), leading to "skip lesions" of no ependymal
cells, and ependymal granulations where they protrude out
Tumor of ependymal cells
Left is normal, can develop a papilloma or carcinoma due to papillary fibrovascular core.
Problem is blocking the ventricles= hydrocephalus
Marker is HAM56, cluster around dying neurons and perform neuronophagia
Cells covering the surface of the brain, form "whorls"
Autoantibodies to the acetylcholine receptor, leads to muscle weakness and ptosis
Ask patient to link their fingers and pull their hands to the side with fingers still linked, and
also perform a Valsalva. This will heighten the appearance of reflexes
Jaw jerk- CN 5
Biceps- C5 and C6
Brachioradialis- C6
Triceps- C7 and C8
Ankle- L5 and S1
Pronator- C6
Knee jerk- L3,4
Low muscle tone and diminished reflexes. Occurs in 3 situations: ventral horn lesion,
peripheral nerve lesion, and early (1-2 weeks) transection of the spinal cord
High muscle tone (rigid, spastic, or clonic) and heightened reflexes. Occurs in 2 situations: late
spinal cord transection and upper motor neuron disease
Early- hypotonia/hyporeflexia

Late- hypertonia/hyperreflexia due to loss of upper motor neuron inhibition of lower motor
neuron through inhibitory interneurons. Also have exaggerated withdrawal response

Sustained muscle contraction at rest. Occurs in 2 diseases: Parkinson's and upper motor
neuron degeneration (tonic part)
No muscle contraction at rest, but an exaggerated response to initiation of muscle
contraction. Occurs in 3 situations: corticospinal (or any motor cortex) lesion, late transection
of spinal cord,
Oscillation and upper
of muscle aftermotor
muscle neuron degeneration-
contraction. tonic
Starts with part
stretching a spastic muscle, leads to
1a afferent reflex
Cutaneous firing and
that spindle
is retainedresponse
in upperto contract the muscle,
motor neuron disease.spindle ceases,
In babies and leads
thoseto muscle
with
relaxation, starts
disease, stroking the whole process over again by stimulating the spindle
lateral sole of the foot causes dorsiflexion of the great toe and fanning of
Herniation of periorbital
the other toes. In adults,fat through
it should the orbital
cause flexionseptum, which is supposed to contain it within
of the toes.
the orbital region
An inflammation of the sebaceous glands around the eye, usually caused by Staph aureus
Inflammation
An inflammation of the tarsal
of the glands that
conjunctiva. Canproduce wax by
be caused on allergies
the tarsal(itchy),
surfaces of the
virus eyelid.
(accompanied by
a cold, also have watery discharge), or bacteria (causes mucopurulent discharge that glues
Damage
lids to facial
together when nerve (CN VII)
sleeping can
andthe leadit to
makes failure
hard of closing
to separate the eye. This is dangerous since
them)
Often, orbital
it doesnt allowfractures involve
the lacrimal gland maxillary
to hydratebone,
the eye,andand
contents of the
tears will fallorbital cavity
down the faceherniate
into the maxillary sinus. Inability to look UP since the inferior rectus and
Marker of hyperthyroidism/Grave's disease, causing abnormal protrusion of the eye (mediatedinferior oblique have
been
by caught
oblique within the
muscles). fracture
Autoantibodies to TSH, TSH is present in the extraocular muscles,
causing protrusion and extraocular muscle
A pathological misalignment of the visual axes hypertrophy
that causes a loss of depth perception. Affects
Caucasians, females, mostly before age 5. Estropia- eye turned INWARD. Exotropia- eye
turned OUTWARD.
Leads to 4 pathologic findings
1. Exotropia (lateral strabismus)
2. Ptosis- inability to open the eye
3. Dilation of pupil
4. Inability to round up lens to accommodate for near vision

Can be caused by thrombosis in posterior communicating artery or cavernous sinus

Leads to subtle head tilt towards Unaffected side. Loss of superior oblique muscle innervation
 Loss of lateral rectus innervation leads to esotropia (medial strabismus) and diplopia (double
vision)

MOST COMMON cranial nerve palsy, common among diabetic patients. Increased intracranial
pressure can put pressure on abducens nerve as well

Result of increased pressure within the eye. Open angle, or closed (canal of Schlemm, which
allows aqueous humor out of the eye from the anterior chamber from where it was made by
the ciliary body in the posterior chamber)

Tested for by allowing a jet of air to hit the cornea and watching the deformity

Second leading cause of blindness

With old age, the ciliary muscles and zonula fibers that flatten the lens to accommodate for
near vision lose their elasticity, leading to an inability to read without reading glasses or
The eyesthings
holding are essentially
farther away an outpocketing
to see them of the central nervous system. Since the central
retinal artery pierces through the dura mater to pass into the eye through the optic disk, it is
exposedby
Caused to chronic
the same HTN CSF pressure
when that the"nicks"
the arteriole brain isthe
exposed
vein onto. Therefore, examination.
fundoscopic you can detect
increased CSF pressure by an increase in diameter of the
Arterioles swell and constrict venous return as they cross the veins optic disk.
Dentists can palpate the mandibular foramen to give anesthesia to the inferior alveolar nerve.
The chin is also numb due to the mental nerve being anesthetized as well
From increased contraction of the lateral pterygoid, the head of the mandible slides over the
articularoften
Benign, tubercle and gets
bilateral bonystuck
protuberances out the mandibular teeth. Common in males, Asian
and Inuit populations
Often involves the neck of the jaw from blunt force trauma
Restricted movement of the tongue due to shortened lingual frenulum
During yawning, the mylohyoid muscle contracts and can compress the submandibular gland,
Wind
leadinginstrument
to a sprayplayers accomplish
of saliva this by closingduct
out the submandibular theirand
oralsublingual
cavity with the soft palate,
caruncle
pulling air into lungs, all while continuing to blow into the instrument through contraction of
3 main causes
buccinator, of sleep
reopen oral apnea: dropped
cavity and exhaletongue, enlarged palatine tonsils, and dropped soft
palate
Infants should never be given a bottle when lying flat on their back. The fluid from the
oropharynx can reflux into the nasopharynx and spread to the inner ear, causing otitis media
Uvular deviation is a sign of lower motor neuron lesion of vagus nerve, since it innervates the
muscularis uvulae
Disease process and
has all the the
affected muscles of the
Schwann soft
cell, palate
not (except
the axon tensor
or the veli fiber.
muscle palatini,
Seewhich is
shorter
innervated and
internodes by trigeminal
thin myelin, 3rdonion
branch)
bulbs are apparent in sequential episodes- thinly
Damage
myelinated is on axon,
axons so surrounding
with there will be Schwann
secondary myelin loss. See various organelles in stages of
cells
degeneration
Demyelinating disease, causing proximal and distal muscle weakness with ascending paralysis
and possible cranial nerve involvement. Onset is about 60 years old (incidence increases with
age), 2/3 are after an influenza like illness. Inflamed and demyelinated peripheral nerves and
spinal nerve roots
Chronic form of above, happening for 2 months or more. Leads to formation of onion bulbs,
infiltration of lymphocytes and macrophages.
Schwann cells infected with M. leprae, symmetric polyneuropathy with loss of pain, cycle of
demyelination and remyelination
Exotoxin-related weakness and paresthesias, demyelination
Latent virus travels sensory nerves to skin, sensory ganglia neuronal degeneration, axonal
Onset about 20
degeneration years
(ONLY old, duplication
INFECTIOUS of PMP22
DISEASE THAT gene
CAUSES leads to peripheral demyelination. Also
THIS)
called "hypertrophic neuropathy" since the nerves seem to get bigger and bigger through
formation
Affects 50%of of
onion bulbs.by
diabetics Distal
age lower extremity
25. Axonal weakness,secondary
degeneration, decreasedmyelin
reflexes, pes
loss. cavus
Loss of small
(high
fibers,arching foot),
symmetric hammertoes
sensorimotor degeneration, thickened arterioles
An infiltrative, benign tumor. In plexiform type, it is almost pathognomic for neurofibromatosis
1
Autosomal dominant, 1 in 3000, mutation in chromosome 17 in tumor suppressor gene causes
neurofibromin protein expression. Causes neurofibromas (plexiform type), gliomas, Lisch
nodules (hamartomas of iris), caf au lait spots, glioma of optic nerve

"Shredded carrot" appearance of tumor

Plexiform neurofibromas can unfortunately evolve into something malignant. Can also be de
novo formation as well. Increased mitoses, necrosis, pleomorphism, growth rate
A benign tumor of neural crest derived Schwann cells that compresses the nerve. Can be
suggestive of Neurofibromatosis 2

Verocay bodies, Anconi A and B regions, hyalinized vessels

Autosomal dominant, 1 in 40,000, mutation in chromosome 22 with merlin protein expression.

Tumors are Schwannomas, most often in cerebellopontine angle, bilateral in CN VIII
(vestibulocochlear), or spinal cord. Often accompanied with multiple meningiomas,
hamartomas, and gliomas.

Tumors have Anconi A (dense) regions and Anconi B (loose) regions. Verocay bodies- areas
where columnar nuclei are all stacked up. Hyalinized vessels- interior layer surrounded with
collagen

Focal- unilateral, asymmetric, due to a structural abnormality

Diffuse- bilateral, symmetric, usually due to a toxic metabolic process

Midline- affects both limbs of upper or lower body. Dont rule this out when diagnosing a
diffuse process unless evidence tells you otherwise

Multifocal- random, aberrant mixtures of symptoms

Radial nerve damage due to trauma. See weakness in extensors, wrist drop, absent triceps
reflex (C6-C8), and anesthesia on the back of the hand
Neuropraxic- demyelination event, recovery occurs in a matter of weeks

Axonotmetic- injury to the axon itself, recovery 1mm/day

Neurotmetic- damage to connective tissue, no recovery

Carpal tunnel syndrome- numbness in 1st, 2nd, 3rd, and half of 4th digits with weakness in
thumb abduction and thenar muscle atrophy, entrapment neuropathy
Numbness over middle finger, weakened extension of arm and absent triceps reflex (C6-C8)
Distal, symmetric polyneuropathy. Stocking and glove pattern, due to high blood glucose. #1
cause of this type of neuropathy!

Length dependent- longest axons are damaged first

#2 cause of distal symmetric polyneuropathy but with negative workup.
Damage in "cool dependent" pattern since the bacteria thrives in the coolest places of the
body
Acute demyelinating polyneuropathy. Presents with "ascending paralysis"- first legs, then
arms, then
Chronic- lungs. Demyelination
occurring for longer thandue to proximal
8 weeks. Samemuscle weakness
symptoms as above but at a lower pace.
Proximal muscle weakness= demyelination
Multifocal neuropathy affecting a random assortment of nerves, due to vasculitis, Lyme
disease, leprosy
 Usually congenital due to the pulling/tearing of sternocleidomastoid during delivery and
shoulder dystocia. Causes shortening of the muscle and head tilt towards the affected side.

Spasmodic contraction of sternocleidomastoid is rare

Used to treat tachycardia to induce reflex bradycardia. Carotid body is a receptor on the
bifurcation of the carotid in the carotid triangle that sends afferent information via CN IX to
the brain, efferent information to slow heart rate via CN X
Sometimes a central line is required to deliver materials directly. The right internal jugular
vein is commonly used since it shoots directly into the superior vena cava. Remember the
layout of the carotid sheath- internal carotid is MEDIAL, internal jugular is LATERAL, vagus
nerve is POSTERIOR. Also, the sympathetic chain lies outside and behind the medial portion

Frequently metastasize via the submental lymph nodes

Ectopic tissue may be left anywhere along the embryonic thyroglossal duct. The pyramidal
lobe is the representation of this ectopic tissue right on the isthmus of the thyroid
A cystic structure left in the embryonic thyroglossal duct, can be present in children aged 2-10
Thyroid ima comes directly from the aorta and is present in a substantial amount of
individuals. This is the reason that emergency airways are NOT used underneath the thyroid
A diaphragmatic spasm causing reflex closure of the glottis. This is a crucial developmental
process for the fetus in utero due to pulling in of growth factors into the lungs from the
amniotic fluid
Represents 25% of head and neck cancers annually. Frequently occurs on true vocal cords due
to the transition of respiratory (ciliated columnar) epithelium to stratified squamous
epithelium

EMERGENCY medical situation in which the epiglottis is inflamed and can lead to blockage in
breathing, may be able to hear stridor. Incidence has gone down since the introduction of the
H. influenzae vaccine, but it can still be caused by Staph aureus or Strep pneumo
Inflammation of the true vocal cords, leads to edema and lack of vibration of the cords, thus
hoarse and raspy voice
1. Tracheostomy- below the cricoid cartilage, above the thyroid
2. Tracheotomy- within the trachea
3. Cricothyroidectomy- between thyroid and cricoid cartilage
K tests Vagus nerve, L tests hypoglossal, M tests facial

Diffuse, not well circumscribed lesion with a mass effect. Peak at age 30-40. LOWEST grade of
astrocytoma. Commonly present with seizures

Gross photo: expansion of tissue, flattening of gyri, asymmetry

Microscopically: entry level grade is a 2. Cells show mild atypia compared to normal
astrocytes. No mitoses. Hard to diagnose- this looks like gliosis

Inactivation of p53, IDH-1 mutation associated with better prognosis and younger age of
onset
 Grade 3 astrocytoma that occurs through the passage of time after diffuse.

Hyperintense "flair" on MRI, can be very infiltrative to GRAY matter tracts.

Microscopically: atypia AND mitoses. Increased cellularity

Also present with seizures, slightly older age

IDH-1 mutation- associated with better prognosis and younger age of onset

Even further passage of time, older person, WHO grade 4. Present with vomiting and
headache that is worsening.

Here, we see enhancement in a rim-pattern.

Like other astrocytomas, can cross the midline via tracts in the corpus callosum. "Butterfly"
tumor pattern

Microscopically: highly cellular, 2 defining features: pseudopalisading necrosis and

microvascular proliferation

Microvascular proliferation is diagnostic

Secondary= IDH-1 mutation, associated with better prognosis and younger age of onset

Secondary- arises from precursor lesion, has p53 inactivation

Primary- more common, arises de novo, NO p53 inactivation, SHORT clinical history

Primary glioblastoma= MOST COMMON PRIMARY BRAIN TUMOR

IDH-1 is frequently mutant in DIFFUSE and ANAPLASTIC astrocytomas, secondary

glioblastoma, and oligodendrocytoma

Associated with BETTER prognosis and younger age of onset

MGMT methylation associated with longer survival in patients who receive alkylating agents

Tumor of children (can present in adults who have had it for a long time), present mostly in
the cerebellum, optic nerve, or 3rd ventricle (not infiltrative, just pushing it aside), cystic with
mural nodule. Can present with headache and vomiting.

Microscopically: Rosenthal fibers (eosinophilic), cells with long hair like projections

WHO Grade 1- very low grade lesion

In optic nerve- can be associated with optic gliosis in Neurofibromatosis 1, can cause
blindness
 Can be in young patients with a long history of seizure disorder, superficial mass interacting
with meninges. Cyst with mural nodule (like pilocytic astrocytoma)

Microscopic: large bizarre cells with chronic inflammation and eosinophilic granular bodies.

WHO Grade 2- same as diffuse astrocytoma

Occurs in lower adulthood.

CT- punctate calcifications

Microscopically: microcalcifications, chicken wire vasculature, "perinuclear" haloes- clear area

around the nucleus, also called Fried Egg nucleus

Cytogenetics: 1p/19q deletions

Classified as WHO Grade 2, can be grade 3 if anaplastic type

Can affect children or adults. Lesion in the periventricular region (children) or intramedullary
spinal cord- sitting within the middle of the cord. Lesion is well demarcated with minimal
infiltration

Microscopically: true rosettes- making a lumen, perivascular pseudorosettes, and canal

formation

Prognosis: WHO Grade 2 or anaplastic Grade 3

DOES NOT always correlate with clinical behavior

WHO Grade 1. Lesion within the conus medullaris outside the cord, NOT intramedullary.

Microscopically: vascular architecture with vessels in the center that are hyalinized. Central
blood vessel surrounded by blue mucin. Blue ependymal cells lining a fibrovascular core
(mucin and vessels)
WHO Grade 1 with cystic and solid parts. Mixed of glia and neurons. May see calcifications as
well. Common
Classic location in temporal
within lobe, may
the lateral present
ventricle with
stuck seizures
onto septumin pellucidum.
kids Marker= NeuN,
neuronal marker to differentiate it from oligodendroglioma. WHO Grade 2
Location in the cerebellum (midline in vermis in kids, hemisphere in adults). Present with
ataxia and vomiting (blockage of CSF)

WHO Grade 4

Microscopically: primitive cells with neuronal and glial differentiation, called "small blue cell
tumor"

Loss of chromosome 17p

Known to shed cells within the CSF due to proximity of ventricles.

 Posterior fossa/supratentorial location. Affects young children under 5 years. Very poor
prognosis, high frequency of hSNF5/INI1 gene loss on chromosome 22. Can be confused with
medullablastoma.

Rhabdoid strap cell is diagnostic.

Lesion that can cross the corpus callosum (like the glioblastoma) and cause a "butterfly"
lesion. Affects middle-older adults, and those who are immunocompromised

Most are B cell lymphomas with a positive CD20 marker. Association with Epstein-Barr virus.

Some lymphomas are very sensitive to preoperative steroids- causes an inability to diagnose
in the OR.

Angiocentric growth pattern- grow around blood vessels

More common in women than men. Extra axial lesion- outside the brain. Sign= "dural tail" of
tumor.

See meningeal "whorls" and Psamomma bodies (dark purple)- whorls of meningeal cells that
have calcified

Association with Neurofibromatosis 2. Has progesterone receptors.

Grades:
1. Well differentiated
2. Atypical
3. Malignant - very high mitotic index

Loss of chromosome 22q (NF2 gene)

Autosomal dominant disease with cysts in pancreas, liver, and kidneys. May have renal cell
carcinoma. Protein is pVHL for ubiquination and VEGF control. Can also be affected with renal
cell carcinoma.

Tumor= capillary hemangioblastoma

Seen in cerebellum and spinal cord, cyst and solid part (mural nodule)
Tumor is very vascular and lipid-rich (see clear vacuoles)
WHO Grade 1
 Location in cerebellum

Gross: mass is sharply demarcated at the gray-white junction, edematous

Microscopically: clues to point to metastatic tumor. Shows adenocarcinoma- glandular and

epithelial. Very well demarcated

Can use tumor marker TTF1 to differentiate tumors from thyroid and lung.

Top 5 Metastases to CNS

1. Lung
2. Breast
3. Skin (melanoma)
4. Kidney
5. GI

Metastasis seeds the subarachnoid space and does not form a solid lesion.

Types that make this pattern:

1. Small cell carcinoma (lots of paraneoplastic syndromes)
2. Adenocarcinoma of breast
3. Adenocarcinoma of lung

Deficit is unilateral, loss of pain, touch, and motor functions. Specific location of damage, not
this level and down.

C5 - biceps relfex
C6 - brachioradialis reflex
C7 - triceps reflex
L4 - knee reflex
L5 - big toe reflex
S1 - ankle reflex

Hemisection of spinal cord or tumor pressing on half the spinal cord. Damage to the long
tracts causes that level loss and DOWN, damage to gray matter causes loss on that level.

Ipsilateral loss of touch/vibration/conscious proprioception from that level on down.

Ipsilateral spastic paralysis from that level on down.

Contralateral loss of pain/temperature from 2 levels and down.

Damage to ventral horn- hypotonia at that level only due to damage of lower motor neuron

Damage to dorsal horn- ipsilateral loss of sensory information at that level alone
Descending control to bladder has been damaged, and we no longer have direction from pons
to empty bladder the way we want to.

Can have overflow incontinence of spastic emptying.

Transection of spinal cord above S2-S4= damage incoming instructions to empty

bladder=voluntary control of bladder emptying is lost
Treatment

Not mentioned

None

None

None
None
None
None
None
None
none
None
None
None
None
None
None
None
None
None
None
None
None
Acetylcholinesterase inhibitors (pyridostigmine)
None

None

None

None

None

None

None

Stop the oscillations by holding the joint in a constant

position
None
Plastic surgery
Not mentioned
Hot compresses 4x a day
Varies depending
Gold eye on cause-
weights can antihistamines,
be sewn into the eyelidantibiotics
to assist in
closing. Levator palpebrae superioris (CN III) has to work
against
Surgicalitwiring
to open the eyelid.
Treatment for Grave's disease

None

Not mentioned

Not mentioned
Not mentioned

Not mentioned.

Reading glasses

Do NOT perform spinal tap

Marker of HTN

None
Put gauze over teeth, places fingers in vestibule of mouth
and apply downward pressure
None
Secured with arch bars surgically
Surgical cutting
Cover your mouth when you yawn
None
Palatouvuloplasty

Feed baby sitting up

None
None
None

Supportive care, IVIG, plasmapheresis

IVIG, steroids, plasmapheresis

None

None

None

None
Control glucose levels
Removal requires removal of nerve as well
Removal

Surgery and subsequent radiation

Removal

None

None

Recovery in 1-8 weeks

None

Release of flexor retinaculum

Identify cause of lesion

Control glucose levels, treat pain

Treat pain
Not mentioned
IVIG, plasmapheresis
Steroids and chronic immunosuppression
Treat underlying cause
Physical therapy

None

None

None
None
Surgery, may require a course of antibiotics before
None

None

None

Emergency medical attention

None

None

None

Observation with serial MRI's

May attempt resection, followed by radiation and chemo

Total gross resection, followed by radiation and chemo

Surgery and debulking, followed by radiation and chemo

Drain cyst, remove solid tumor (mural nodule). Prognosis

better than diffuse astrocytoma
Surgical resection. Prognosis is relatively better than diffuse
astrocytoma

Surgery, 1p/19q deletion predicts response to

chemotherapy (some treatments work well), radiotherapy
may be delayed

Grade for grade, an oligodendroglioma behaves BETTER

than any astrocytoma

Resection from within the tumor

If periventricular, gross total resection is not possible

Can have radiation following surgery

Resection
Surgical resection

Partial resection as much as possible, radiosensitive (not

good to give radiation to child), 5 years survival is 75%
Poor prognosis

Surgery for biopsy, steroids AFTER operation, radiation,

chemo

They respond so well to steroids that surgical resection is

generally not needed

Prognosis: tumor will disappear with steroids, but it can

return eventually

Surgery, sometimes radiation

Resection- be careful due to increased vascularity

Surgery, radiation, chemo

Surgery (cannot perform with diffuse seeding), radiation,

chemo

Surgery

Resection of compressing structure

Catheterization
Photo

Normal tissue on bottom. Blue background

Axonal reaction- damage to axon leads to cell body swelling

none

None

None

None

None

None

None
None

None

None

None

None

none

none
None

None

None

None

None
none
Brown pigmented melanoma
None
Pathology
Hyperopia
Myopia
Astigmatism
Cataracts

Snellen Acuity Notation

Legal Blindness

LASIK

Management via EXCIMER

Corneal Transplantation

Branchial Remnants

Thyroglossal Cyst

Thyroid Ectopia

Inspection Abnormalities

Alopecia Areata
TMJ Syndrome
Acromegaly
Pierre Robin Sequence
Down Syndrome
Hyperthyroid Facies
Torticollis (Wryneck)

Pathology in Eye Exam

Weber Test

Rinne Test

Dix Hallpike Maneuver

Labrynthitis
Septal Deviation
Nasal Polyps
Oral Tori

Tonsil Pathology

Bell Palsy

Abducens Palsy

Nasal Cilia

Deviated Nasal Septum

Anosmia
Epistaxis from Kiesselbach's Plexus

Pain Relief from Broken Nose

Sinusitis

Referred Pain for Paranasal Sinuses

Broken Nose

Heimlich Maneuver

Virchow's Node

Cleft Lip and Palate

Brachiooculofacial Syndrome
Treacher-Collins
DiGeorge Syndrome

Van der Woude Syndrome

Pierre Robin Sequence
Hemifacial Microsomia
Holoprosencephaly
Fetal Alcohol Syndrome/Fetal Alcohol
Spectrum Disorder

Disorders in Thought Process

Disorders in Thought Content

Delirium

Visual Field Deficits

Deuteranopia

Protanopia

Prosopagnosia

DSM-IV-TR Multiaxial System

Anxiety Disorders
Post Traumatic Stress Disorder

Acute Stress Disorder

Obsessive Compulsive Disorder (OCD)

Panic Disorder

Generalized Anxiety Disorder

Specific Phobia
Social Anxiety Disorder

Anxiety Disorder Related to General

Medical Condition
Substance Induced Anxiety Disorder

Anxiety Disorder NOS

Attention-Deficit-Hyperactivity Disorder
(ADHD)

Anosmia

Visual Field Deficits and Common

Causes
Horner Syndrome

Oculomotor Nerve Lesion

Trochlear Nerve Lesion

Abducens Nerve Palsy

Trigeminal Neuralgia

Bell's Palsy

Ramsay Hunt Syndrome

Acoustic Neuroma

Lesions of CN IX

Vagus Nerve Lesions

Vagal Reflex

Sudden Firing of CN XI
Lower Motor Neuron Lesion of CN XII
Monocular Visual Defect
Bitemporal Hemianopia
Binasal Hemianopia
Homonymous Hemianopia
Upper Quadrantanopia
Lower Quadrantanopia
Homonymous Hemianopia with Macular
Sparing
Complete Visual Loss

Congruent vs Incongruent Lesions

Left Optic Neuropathy

Chiasmal Lesion/Pituitary Apoplexy

Optic "Tractopathy"

Anton Syndrome
Symptoms
"Farsighted", can see far away but have trouble with close up vision. This is because
the light rays converge
"Nearsighted", can see upon close
a spotbut
behind theaway.
not far retinaThis is because the focal point is
anterior
A
The most(in
condition front
common of)cause
in which the
the retina
curvature of the
of reversible eye creates
blindness in the2 world.
focal points, thus the
Over time, decreasing
lens
visual acuity/quality
accumulates debris and inclusions until it gets so cloudy that it forms an actual
opaque mass in the eye. Needless to say, this decreases visual acuity to a great
degree Numerator= how many feet away from the chart
Denominator= how many feet it SEEMS you are away from the chart based on your
acuity

Example- 20/50. Subject is standing 20 feet from the chart, but it seems as if they are
50 feet away from the chart because of their lack of clarity of vision

A legal definition, visual acuity of 20/200 or worse in the better seeing eye, less than
20 degrees visual field

A type of surgery in which a laser makes a flap in the cornea. Then, the lens is
reshaped to better use the curvature to increase the power. Since endothelial cells
are in the eye constantly sucking aqueous humor from the anterior pressure, the
Laser to correct
negative curvature
pressure created of the eye to pull
is enough maximize power
the flap back(remember,
onto the eyethe radius
and heal is
inverse to the curvature and power).

Hyperopia= shave more off the sides

Myopia= shave more off the center for the ideal curvature
Can see "cookie cutter" line in between donor and recipient sites that have been
sewn together
A remnant of the cervical sinus, formed by the 2nd branchial arch draping over the
others to create this internally.

Cyst- closed on both ends

Sinus- open on one end
Fistula- open on both ends

All of these will present LATERALLY

A remnant of the thyroglossal duct, which the thyroid uses to migrate downward to
its position in the normal anatomic position. It is marked by the foramen cecum. Cyst-
closed on both ends

This will be MIDLINE

A remnant of the thyroid that has not completed its descent, thus taking up
radioactive molecules and producing increased amounts of TSH
Tumor= most common is neurofibroma.

Scars are evident. Also see consequences of hydrocephalus and early suture closing
A coin shaped area of lost hair, commonly presents in children. Can be distinguished
from hair pulling since the whole hair is missing.
Popping, locking, pain, crepitus in TMJ may all point to this overuse syndrome
Frontal bossing, prominent malar bones, wide nasal dorsum from increased growth
hormone
Micrognathia, glossoptosis, and cleft palate.
Rounded medial canthus, up slanted eyes, protruding tongue, microcephaly, flat nose
Exopthalamos, startled expression, fine hair, may seen nervous/anxious, eyelid
A hematoma from trauma (usually a birth injury) leads to spontaneous rupture or tear
retraction
of the sternocleidomastoid muscle, causing a turned head and shortened neck on one
side
Pseudostrabismus- may be seen in children. Can differentiate from true strabismus by
looking at the location of the pupil and making sure it is midline

HTN- see blotchy hemorrhages on fundoscopic exam

A test for conductive hearing loss. Activate tuning fork and place it on the head of the
patient

Louder on one ear than the other= conductive hearing loss

Another test for conductive vs sensory hearing loss. Activate tuning fork, place it
against the mastoid process, then in front of the ear.

Normal= louder in front of the ear

Louder on mastoid process= conductive hearing loss
Have patient lie with legs forward and drop their head off the table and slowly turn
their head.

Upward nystagmus= brain issue

Downward nystagmus= inner ear issue
Infection of the inner ear
Usually caused by trauma, nasal septum is pushed over to one side. Can risk
hematoma and severe blood loss
Outgrowth of nasal tissue, strongly associated with cystic fibrosis
Bony, benign protrusions out the maxilla or mandible near the teeth. Higher in Asian
and Inuit populations
Tonsilar pits= can be cause of chronic bad breath

Abscesses in tonsils can cause uvular deviation

Tonsils grow until about age 8, then should regress slowly. Chronically swollen tonsils
in teen/adult= consider tonsillectomy
Facial nerve (CN VII) palsy, leads to inability to close mouth (orbicularis oris), cannot
close eye (orbicularis oculi), and paralyzed muscles of facial expression
CN VI palsy, most common cranial nerve palsy, especially in diabetics.

Medial strabismus and diplopia (due to loss of innervation of superior oblique muscle)

Can be affected by heat, cold, dryness, or drugs. Beat towards the posterior
nasopharynx to decrease mucus buildup and prevent infection

Septum is rarely located exactly within the midline, can deviate to one side and
interfere with breathing
Defined as the loss of olfaction. Can be regenerated, but not if the olfactory bulbs are
largely displaced off the cribiform plate. Can see CSF rhinorrhea and the "double ring
sign"- ring of CSF around ring of blood
Nosebleed commonly occurs from Kiesselbach's plexus and includes the following 4
arteries: anterior ethmoid (off ophthalmic, which is off the internal carotid), superior
labial (off facial, which is off the external carotid), greater palatine, sphenopalatine
(exits out sphenopalatine foramen along with nasopalatine nerve in pterygopalatine
fossa)

3 ways
1. Packing of nose with gauze soaked in topical anesthetic
2. Injection to anterior ethmoid nerve (V1)
3. Injection to infraorbital nerve (V2)
Inflammation of the sinuses, usually from a bacterial infection. Can also be from
viral/allergy cause
Frontal- pressing on frontal bone
Maxillary- pressing on maxilla, referred to maxillary teeth
Sphenoid- refers to the top of the head
Ethmoid- refers to lateral and medial sides of eyes
Nose can be forcibly displaced from lateral nasal cartilages and broken in the
perpendicular plates of the ethmoid bone as well as the vomer.

Used to dislodge food from the narrowest portion of the pharynx where it meets the
epiglottis due to reflex closure of the glottis

Left supraclavicular lymph node enlargement is indicative of visceral metastatic

neoplasm

Occurs 1/700 births. Cleft lip is more common in males and is due to the failure of the
medial nasal prominence to fuse with the maxillary process (from 1st branchial arch).
Cleft palate is more common in females and is due to the failure of fusion of the
palatal shelves.

Atypical clefting is due to failure of medial and lateral nasal prominences to fuse with
the maxillary prominence.

Midline clefting is due to the failure of fusion between the 2 medial nasal
prominences

A type of first arch syndrome (neurocristopathy) resulting in a pseudocleft in the

philtrum.neurocristopathy
Another Also see microcephaly,
markedbroad nasal bridge, malformed
by missing/malformed ears,and
ears, malar large forehead
mandibular
hypoplasia, down slanting palpebral fissures
CATCH 22
Cardiac anomaly
Abnormal facies (hypertelorism)
Thymic aplasia and T cell deficiency
Cleft palate
Hypoparathyroidism, hypocalcemia
22 chromosomal deletion
Neurocristopathy characterized by lip pits. Also see cleft lip and/or palate
Called a "sequence" because of one anomaly leading to others. Micrognathia leads to
glossoptosis (posteriorly
Neurocristopathy placed
affecting lowertongue), which
1/2 of one sideleads
of thetoface
cleft(mandible
palate and ears),
A disorder characterized
preauricular skin tags by SHH mutation, leading to failure of midline structures to
FAS occurs
develop. Can0.5-2 in 1000
be as births,
mild as FASD 10
one incisor in 1,000
tooth, or asbirths.
severeGreatest sensitivity
as cyclopia. to
1 in 250
alcohol is in the first month when midline structures are
conceptus, 1 in 8,000 births. #1 forebrain structural defect developed. Alcohol causes
apoptosis of neural crest cells. Even 1 binge (or low lying levels) can cause this
disorder
Circumstantiality- point reached after taking a circuitous path to get there

Tangentially- point never reached due to going off on a tangent

Loose association- no connection from 1 idea to another

Flight of ideas- fast stream of thoughts and speech

Neologisms- made up words

Word salad- random pairings of nonsensical words

Clang association- saying words that have similar phonetics but no meaning (My
truck is red. I am in bed)

Thought block- abrupt cessation of communication, cut yourself off

Delusion- fixed false beliefs not shared by society/culture and not changed by
reasoning

Suicidal ideation- if you ask a suicidal person if they are suicidal, they will probably
answer "No" so you won't stop them

Phobia- irrational fear

Obsession- intrusive and repetitive thoughts

Compulsion- repetitive behaviors linked to obsessive thoughts

Disturbance of attention, behavior, consciousness, cognition developing over a short
period of time (hours-days) and fluctuating during the course of a day.

Causes: organ dysfunction, electrolyte and hormonal imbalances, epilepsy, trauma,

drugs (sedatives, opiates, steroids), poisons, vitamin deficiency, post operatively

Anoxia is defined as low O2 delivery to the brain. This causes an influx of calcium and
sodium. This leads to an increase in activity of tyrosine hydroxylase, making more
dopamine. Dopamine beta hydroxylase is inhibited due to low oxygen levels, so
dopamine cannot be converted to norepinephrine. Instead, it takes more toxic
metabolic pathways for degradation

Red/green color blindness, more common in males. Blue and yellow show up as gray

Blue color blindness, more rare, even in both males and females

Lesion in the inferotemporal cortex can lead to inability to recognize faces ("face
blindness")

1. General psychologic disorder

2. Personality or developmental disorder
3. Disorder due to medical condition
4. How well they are functioning
5. Estimate from 1-100 of level of functioning

Onset between 15-21, more common in females, variable course over lifetime,
genetic/familial basis, can be found comorbid with mood disorders, can be prominent
in some personality disorders. Localized to limbic system (particularly amygdala
activity), underactive serotonin, overactive norepinephrine, can be related to
Hypothalamic-Pituitary Axis and steroids as well due to the stress response.
Dominance of activity within the sympathetic nervous system. Inactivity of GABA,
overactivity of glutamate.

Chronic stress response-

Exposed to a traumatic event, and this traumatic event is re-experienced. Avoidance
of related stimuli, emotional numbness, persistent arousal (exaggerated startle
reflex), duration is LONGER than 1 month. 7-8% lifetime prevalence

Same as above, but duration is SHORTER than 1 month

Obsessions- recurrent thoughts or images, not excessive worries or psychosis (person

realizes that they are thinking about strange things). Compulsions- recurrent
behaviors the patient feels driven to perform to reduce distress, excessive and not
rationally connected. Produces personal, social, and occupational dysfunctional. 2.5%
lifetime prevalence

Recurrent, non triggered panic attacks, rapid experience of sudden anxiety (peak
around 10 minutes), associated with multiple features (4 needed for diagnosis): chest
pain, chills/hot flash, derealization or depersonalization, fear of losing control,
dizzy/unsteady/lightheaded, choking, nausea, palpitations, paresthesias, shortness of
breath, impending doom sense, sweating, trembling.

Concern, worry, change in behavior due to fear of attacks for 1 month or longer. WITH
agoraphobia- fear of being places where escape is difficult or a companion is
required. WITHOUT agoraphobia as well. 3.5% lifetime prevalence (40% with
agoraphobia)

Excessive worry about multiple events or activities, subjective difficulty redirecting

worry, over 6 months duration, need 3 of 6 features: restlessness, easily fatigued,
difficulty concentrating, irritability, muscle tension, sleep disturbance. 5%lifetime
prevalence
Excessive, cued or reflexive fear that is irrational. Exposure produces immediate
anxiety,
Fear prominent
of one or moreavoidance of trigger, associated
social activities/performance distress perception
situations, interferes with person's
of scrutiny by
function.
others, Differentproduces
exposure from panic disorder-anxiety.
immediate some specific thing as
Recognized triggers this immediately.
unreasonable,
25% lifetime
avoidance of prevalence
social situations, social situations are endured with distress. 13%
lifetime prevalence

Anxiety is physiologically related to a known medical condition. Ex- hyperthyroidism

Anxiety is physiologically related to the effects/withdrawal of a substance or
medication

Anxiety is present but doesn't meet criteria for one of the other disorders

NOT related to meningitis, NOT related to brain damage, NOT a disorder that children
grow out of, NOT just medications work as therapy. Thought to be related to
parenting and environment- prenatal toxins, too much sugar. Criteria: either
inattention (careless mistakes in work or school, doesnt seem to listen, fails to finish
tasks, reluctant to engage in tasks with increased mental effort, need 6 or more of
these) or hyperactivity/impulsivity (fidgets, leaves seat, difficulty playing quietly,
talks excessively, acts "on the go", runs about or climbs excessively). Clear evidence
of significant impairment. Symptoms present BEFORE 12 years and impairing ability
to function in social or occupational settings.

Can have combined, primarily inattentive type, or primarily hyperactive-impulsive

type

Comorbid lifetime diagnoses in children: conduct disorder, substance abuse. In

adults: GAD, alcohol abuse, major depressive disorder, OCD, antisocial personality
disorder

Prominence of executive dysfunction: response inhibition (frontal lobe), vigilance

(frontal, parietal, midbrain, brainstem), working memory (prefrontal cortex), planning
(frontal lobe)

ADHD is more common in males. However, males and females both had similar error
rates in strategic planning. Girls usually have more of the inattentive type.

Conscious attention- found in frontal eye fields, lateral intraparietal areas.

Nonconscious attention- subcortical circuits. Norepinephrine and dopamine are the
major neurotransmitters of attention

Signals- N100 seen in frontotemporal regions, unpredictability. N200 in anterior

regions, mismatch negativity. P300- frontal, central, parietal. Frontal and central (P3a)
for decision making, parietal (P3b) for improbability of event during task engagement

May see reduced right frontal cortical thickness in adults and children
Loss of smell. With hypogonadism= Kallmann syndrome. If olfactory bulbs are not
significantly displaced, then regeneration may be able to occur

Complete loss of vision in one eye= orbital tumor

Bitemporal hemianopia- pituitary tumor

Homonymous hemianopia- middle cerebral artery infarct

 Ptosis, miosis, anhidrosis due to loss of sympathetic innervation

Ptosis- loss of superior tarsal muscle to lift up the eye

Miosis- loss of sympathetic innervation to dilator pupillae

Lateral strabismus, ptosis, decreased accommodation for near vision, and dilated
pupil ("down and out")

Can be due to vascular occlusions (strokes) in the following places

1. Posterior cerebral a.
2. Posterior communicating a.
3. Superior cerebellar a.
4. Cavernous sinus

Subtle head tilt towards the UNaffected side to reduce diplopia, loss of movement of
eye by the superior oblique (Fully adducted, then down)

Can be due to stroke in the following arteries

1. Posterior cerebral
2. Superior cerebellar

Most common CN palsy, common in diabetics. Marked by medial strabismus and

diplopia.

May be caused by stroke in the following arteries:

1. Basilar
2. Posterior inferior cerebellar

Also known as "Tic doloureux", a severe and sudden pain in one of the branches of
the trigeminal nerve (usually ophthalmic or mandibular)

Paralysis of facial nerve branches, leads to eye being unable to close and tearing,
mouth being unable to close and drooling.

***To tell if it is Bell palsy or stroke, ask patient to wrinkle forehead. If they CANNOT=
Bell palsy. If they CAN and the lower half of the ipsilateral face is paralyzed= STROKE
(UMN Lesion)
A painful infection of the facial nerve by herpes zoster virus, causing eruption of
vesicles and plaques near the space on the auditory canal that the facial nerve
innervates
Schwannoma of CNVIII or at the cerebellopontine angle, strongly suggestive of
neurofibromatosis 2

Causes decreased gag reflex (CN IX carries afferent limb, CN X carries efferent limb)

Hoarseness, trouble swallowing, and uvular deviation to Unaffected side due to loss
of innervation of the levator palati muscle
Since the vagus nerve innervates part of the auditory canal, there can be an
increased gag/cough reflex when looking into the ears
Causes torticollis, a shortening of the sternocleidomastoid, and a head tilt towards
the shortened muscle
Tongue will point to AFFECTED side
Vision loss is ipsilateral eye, usually due to a lesion in the optic nerve. Can test optic
nerve lesion with + color desaturation and + Swinging Flashlight test
Usually due to a lesion in the optic chiasm (pituitary adenoma)
Due to lesions COMPRESSING the lateral sides of the optic chiasm or bilateral internal
carotid artery
Visual field aneurysms
deficit in contralateral visual field as the lesion in both eyes. Can be in the
optic tract,
Lesion the
in the parietalfiber
R Meyer andbundle
Meyer fiber bundles,lobe)
(or temporal or inwill
thecause
occipital cortex
L upper visual field
deficits
Lesion
Macularinsparing
the R parietal
means lobe or fiber
that the bundle
middle partleads
of thetovisual
L lower field
field deficitsby the optic
is spared
nerve, which is a very good thing. From stroke of the posterior cerebral artery. The
Can be cerebral
middle due to the following:
artery Basilar
will still artery
be able occlusion,
to provide bloodchiasmal lesion, mid
to the occipital occipital
pole
lesion
Congruency means that the visual field deficits look similar in both eyes. Congruency
increases as you move farther posteriorly in the brain. Anterior lesions are more
incongruent than posterior lesions
Can be first sign of MS, especially in a young woman. See blurred vision (not
Happens
completely frequently
gone) in in pregnant
one eye, pale women. Can lead to bitemporal hemianopia, or
optic disk
lesions that are more severe than that due to how much the pituitary is pressing onto
or around the chiasm

Can be due to anterior choroidal artery occlusion. Loss of myelination of the optic
tract leads to homonymous hemianopia

Lesion in the visual cortex + visual association areas. Patient will have a complete
vision loss, but they wont know that they cannot see due to the loss of visual memory
storage and association areas. Can be due to encephalopathy with HTN
Treatment (+, convex) lens to cause the
Converging
focal point to move anterior and converge
Diverging
Surgery
onto thevia (-,phacoemulsification-
retinaconcave) lens causesultrasound
the focal
point
Does to
notmove back
necessarily onto
meanthe retina
you are
waves hit the opaque mass, can remove not a it
candidate for LASIK
while still keeping the lens's natural shell,
then insert an intraocular lens that unfolds to
enter the shell of the lens and restore normal
function/power of the lens
None

None

None

None

Potential complication= irregular astigmatism

from different tensile strengths of each suture

Surgery

Surgical correction

Surgery

None

Not mentioned
Not mentioned
GH antagonists
Not mentioned
None
Not mentioned
Not mentioned

None

None

None

None

None
Sometimes surgical intervention
None
None

None

Not mentioned

None

None

Surgical correction

Splint for broken nose

Two of these arteries can be manually
compressed: superior labial (press on upper
lip) and greater palatine (press on hard
palate), then cautery

None

None

None
Put elevator into nostril, raise the nostril to
normal height with pressure put on the other
side by the thumb, splint and pack the nose
for
For proper
adults-healing
find the navel, roll hand upwards,
and compress towards the ceiling to force
food out.

Children under 7- perform this same motion

with the child on their back

Infants- place them prone on your knee,

perform same superior motion to dislodge
food

None

Surgical intervention

Not mentioned
Plastic surgery can enhance appearance
Not mentioned

Not mentioned
Not mentioned
Not mentioned
Not mentioned
Not mentioned

Take all these signs into consideration when

forming a diagnosis

Take all these signs into consideration when

forming a diagnosis
Haloperidol- dopamine antagonist to lower
dopamine levels. Need to restore O2 delivery
to the brain and determine etiology

None

None

None

None

Most patients are cognizant of their

symptoms.

SSRI, behavioral therapy. May need addition

of antioxylitics, antipsychotics, mood
stabilizer
Patient may be avoidant or reluctant to
discuss symptoms. Be aware of DSM
symptoms- ask and observe. SSRI, behavioral
therapy. May need addition of antioxylitics,
antipsychotics, mood stabilizer
Be aware of DSM symptoms- ask and
observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer

Be aware of DSM symptoms- ask and

observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer

Be aware of DSM symptoms- ask and

observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer

Be aware of DSM symptoms- ask and

observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer
Be aware of DSM symptoms- ask and
observe.
Be awareSSRI, behavioral
of DSM symptoms- therapy. May need
ask and
addition of antioxylitics, antipsychotics,
observe. SSRI, behavioral therapy. May need mood
stabilizer. Exposure therapy (graded, or
addition of antioxylitics, antipsychotics, mood
flooded) Exposure therapy (graded, or
stabilizer.
flooded)
Be aware of DSM symptoms- ask and
observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer
Be aware of DSM symptoms- ask and
observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer

Be aware of DSM symptoms- ask and

observe. SSRI, behavioral therapy. May need
addition of antioxylitics, antipsychotics, mood
stabilizer

Psychological therapy- chores, lists,

reinforcements, assisting dysfunctional
frontal lobe systems.

Stimulant medications- Amphetamine and

derivatives, Methylphenidate (dopamine
agonist). Enhance dopamine and
norepinephrine

None

None
Not mentioned

Not mentioned

Not mentioned

None

Not mentioned

Usually temporary

Steroids, pain management, and antiviral

medication
None

None

None
None

None
None
None
None
None
None
None
none
None
None

None

None
Emergency surgery

None

None
Photo

None

None
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None
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None
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None
none

None

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None

None
none

none

none

none

none

none
none

None

None
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None
None

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None