disinhibition and deficit in concentration, orientation, judgement; may have reemergence of primitive reflex

eye look toward side of lesion; in seizure, eye look away from side of lesion

internuclear ophthalmoplegia(核間性眼筋麻痺): impaired adduction of ipsilateral eye; nystagmus(眼振) of contralateral eye with abduction

agraphia(失書症), acalculia(失計算), finger agnosia, left-right disorientation

agnosia(失認) of contralateral side of the world; hemispatial neglect syndrome(半側空間無視)

CT detects ischemic change in 6-24hr, diffusion-weight MRI within 3-30min

place: hippocampus, neocortex, cerebellum, watershed areas

12-24hr: eosinophilic cytoplasm, pyknotic nuclei(核濃縮)

acute blockage of vessels→disruption of blood flow and subsequent ischemia→liquefactive necrosis

due to a clot forming directly at site of infarction, usually over an atherosclerotic plaque

brief, reversible episode of focal neurologic dysfunction without acute infarction, with the majority resolving in 15 minutes, due to focal ischemia

altered level of consciousness, bulging fontanelle(大泉門隆起), hypotension, seizures, coma

scalp hematoma, rapid intracranial expansion under systemic arterial pressure→transtentorial herniation(テント切痕ヘルニア), CN3 palsy

biconvex(両凸), hyperdense blood collection not crossing suture lines(縫合線)

rupture of meddile meningeal artery, often due to skull fracture involving the pterion

crescent-shaped hemorrhage that cross suture lines, midline shift

rupture of bridging veins, acute(hyperdense) or chronic(hypodense)

worst headache of my life, bloody or yellow spinal tap, vasospasm 3-10 days after hemorrhage→ischemic infarct (use nimodipine to prevent vasospasm

bleeding due to trauma or rupture of aneurysm or arteriovenous malformation, rapid

Charcot-Bounchard microaneurysm commonly occur in putamen(被殻) of basal ganglia

commonly caused by systemic hypertension, also seen with amyloid angiopathy, vasculitis, neoplasm

contralateral paralysis and sensory loss, aphegia (dominant hemisphere), hemineglect(nondominant)

motor and censory cortices(upper limb and face), tamporal lobe(Wernicke srea), fronatal lobe(Broca area)

caudal medulla(hypoglossal nerve)→ipsilateral hypoglossal dysfunction

lateral corticospinal tract→contralateral paralysis(upper and lower limbs)

medial medullary syndrome: infarct of paramedian branches of ASA and/or vertebral artery

lateral medulla;nucleus ambiguus→dysphagia, hoarseness, ↓gag reflex, hiccups; vestibular nuclei(前庭神経核)→vomiting, vertigo, nystagmus; lateral spinothalamic tract, spinal trigeminal tract→↓pain and temperature sensation(contralateral body, ipsilateral face); sympathetic fiber→ipsilateral Horner syndrome; inferior cerebellar peduncle→ipsilateral ataxia, dysmetria

facial nucleus→paralysis of face, ↓lacrimation, salivation, taste from anterior 2/3 of tongue

spinothalamic tract, spinal trigeminal nucleus→↓pain and temperature sensation (contralateral body, ipsilateral face)

middle and inferior penduncles→ataxia, dysmetria(測定障害)

labyrinthine artery(迷路動脈)→ipsilateral sensorineural deafness, vertigo

corticospinal and corticobulbar tract→loss of voluntary facial, mouth and tongue movement

ocular nerve nuclei, paramedian pontine reticular formation→loss of horizontal eye movement

pons, medulla, lower midbrain→reticular activating system(RAS) spared, therefore preserved consciousness

occipital lobe→contralateral hemianopia with macular sparing, alexia(失語) without agrephia(失書)

aphasia: higher order language deficit, caused by pathology in dominant cerebral hemisphere

characterized by synchronized, high-frequency neuronal firing

simple partial: consciousness intact, motor, sensory, sutonomic, psychic

absence: 3 Hz spike-and-wave discharges, no postictal(発作後), blank stare

continuous or recurring seizure that may result in brain injury

treatment: cluster→sumatriptan, O₂; others→NSAIDs,etc

excruciating(耐え難い) periorbital pain with lacrimation and rhinorrhea(鼻漏)

slow, snake-like, writhing(もがく) movement especially in finger (basal ganglia)

high frequency tremor with sustained posture, worsened with movement or when anxious

loss of dopaminergic neurons of substantia nigria pars compacta(黒質緻密部)

tremor, rigidity, akinesia(無動症), postural instability, shuffling gait(引きずり歩行)

AD trinucleotide repeat expansion in the huntingtin gene on chromosomal4, age 20 to 50

widespread cortical atrophy, especially hippocampus, narrowing of gyri and widening of sulci

associated with altered proteins: ApoE-2, ApoE-4, APP, presenilin-1,2

senile plaque(老人斑) (extracellular β-amyloid core); neurofibrillary tangles(神経原線維濃縮体) (intracellular, hyperphosphorylated tau protein

most common cause of dementia in elderly, Down syndrome patients have ↑risk, ↓ACh

inclusion of hyperphosphorylated tau protein (round Pick body) or ubiquitinated TDP-43

visual hallucination, dementia, REM sleep behavior disorder, parkisonism

risk factors: female, tetracycline, obesity, vitamin A excess, danazol

lumbar puncture(腰椎穿刺) reveals ↑opening pressure and provides temporary headache relief

↓CSF absorption by arachnoid granulations→↑ICP, papilledema, herniation

urinary incontinence, gait apraxia(歩行失行), cognitive dysfunction

elderly, idiopathic, not increased subarachnoid space volume, expansion of ventricles distorts the fiber of corona radiata(放射冠)

caused by structural blockage of CSF circulation within ventricular system

exacerbate with increased body temperature, relapsing and remitting(緩和する), women in 20s and 30s

↑IgG, ↑myelin basic protein in CSF, oligoclonal band, periventricular plaques, multiple white matter lesion disseminated

acute optic neuritis, brainstem/cerebellar syndrome, pyramidal tract weakness, spinal cord syndrome

treatment: IV steroids(acute flare); symptomatic treatment; disease-modifying therapy

autoimmune inflammation and demyelination of CNS with axonal damage

acute paralysis, dysarthia, dysphagia, diplopia, loss of consciousness

massive axonal demyelination in pontine white matter due to rapid osmotic damage

autoimmune condition associated with infection, inflammation and demyelination of peripheral nerve and motor fibers

symmetric ascending muscle weakness/paralysis and depressed DTR(深部腱反射), other neural defect

multifocal inflammation and demyelination after infection or vaccination

progressive hereditary nerve disorders related to defective production of protein →defective peripheral nerves or myelin sheath

demyelination of CNS due to destruction of oligodendrocyte

Krabbe disease, metachromatic leukodystrophy, adrenoleukodystrophy

congenital, noninherited, developmental anomaly of neural crest due to somatic mosaicism (mutation in GNAQ gene)

port-wine stain of the face, ipsilateral leptomeningeal angioma(軟髄膜血管腫), seizure, epilepsy, intellectual disability, glaucoma

hamartomas(過誤腫), angiofibromas, mitral regurgitation, ash-leaf spot, cardiac rhabdomyoma, mental retardation, renal angiomyolipoma, seizure

cafe-au-leit spot, cutaneous neurofibromas, optic gliomas, pheochromocytomas, Lisch nodules

bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependymomas

hemangioblastomas in retina, brain stem, cerebellum, spine, angiomatosis, bilateral renal cellcarcinoma, pheochromocytomas

GFAP+, pseudopalisading(偽柵状配列) plemorphic tumor cell border central areas of necrosis, hemorrhage, microvascular proliferation

grade 4 astrocytoma, common, malignant, found in cerebral hemisphere, astrocyte origin

most often in frontal lobe, slow growing, oligodendrocyte origin

often symptomatic, may present with seizures or focal neurologic signs

apindle cells concentrically arranged, psammoma bodies(砂粒小体)

common, typically benign, female, near surface of brain and parasagittal region(傍矢状域), arachnoid cell origin

closely arranged, thin walled capillaries with minimal intervening paranchyma(実質)

most often cerebellar, associated with von Hippel Lindau syndrome, produce EPO, blood vessel origin

mass effect: bitemporal hemianopia, hypopituitarism, headache

nonfunctioning or hyperfunctioning, most commonly prolactinoma; less comonly adenoma producing GH, ACTH; rarely, TSH, FSH, LH

plolactinoma→galactorrhea, amenorrhea, ↓ bone density, low libido, infertility

treatment: dopamin agonist, transsphenoidal(経蝶形骨洞) resection

dense, hypercellular areas containing spindle cells→hypocallular and myxoid areas

at cerebellopontine angle, CN7,8 and peripheral nerve, schwann cell origin, S-100+

caudal displacement of brain stem→rupture of paramedian basilar artery branch→Duret hemorrhage

compress ipsilateral CN3 and contralateral crus cerebri(大脳脚)→contralateral CN3 palsy and ipsilateral hemiparesis

congenital degeneration of anterior horn, LMN only, symmetric, hypotonia, tongue fasciculation, AR(SMN1 gene)

LMN→dysarthria, dysphagia, asymmetric limb weakness, fasciculations, atrophy)

UMN→dysarthria, dysphagia, emotional lability, spatic gait, clonus

UMN deficit below the lesion; LMN deficit at level of the lesion; loss of pain and sansation below the lesion

mid-thoracic ASA teritory is watershed area, can be caused by aortic aneurysm repair

asymmetric weakness, hypotonia, flaccid paralysis(弛緩性麻痺), fasciculation, hypoflexia, muscle atrophy

destruction of cells in anterior horn of spinal cord(LMN death)

contralateral loss of pain, temperature, crude touch below level of lesion

ipsilateral UMN signs, ipsilateral loss of proprioception , vibration, light touch, tactile sense(触覚) below level of lesion

ipsilateral loss of all sensation, ipsilateral LMN sign at level of lesion

degeneration of lateral corticospinal tract, spinocerebellar tract, dorsal column, dorsal root ganglia

AR trinucleotide repeat disorder(GAA on 9:encode frataxin)

staggering gait(よろめき歩行), frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy, kyphoscoliosis(脊柱後側弯症)

jaw deviate toward side of lesion due to unopposed force from the opposite pterygoid muscle(翼突筋)

weakness turning head to contralateral side of lesion(SCM), shoulder droop on side of lesion(trapezius)

LMN lesion, tongue deviate toward side of lesion due to weakened tongue muscle on affected side

usually after HSV; other causes are Lyme disease, herpes zoster, sarcoidosis, tumor, diabetes mellitus

Bell palsy is the most common cause of peripheral facial palsy

motor cortex, connection from motor cortex to facial nucleus in pons

incomplete eye closure, hyperacusis(聴覚過敏), loss of taste sensation to anterior tongue

aging related progressive bilateral sensorineural hearing loss due to destruction of hair cells at cochlear base

overgrowth of desquamated keratin debris within middle ear space

may erode ossicles, mastoid air(乳突蜂巣) cells→conductive hearing loss

semicircular canal debris, vestibular nerve infection, Meniere disease, benign paroxysmal positional vertigo(良性発作性頭位めまい症)

viral: most common, often adenovirus, sparse mucous discharge, swollen preauricular node, self resolving

farsightedness, light focused behind retina, corect with convex lenses(凸レンズ)

nearsightness, light focused in front of retina, correct with concave lenses(凹レンズ)

abnormal curvature of cornea→different refractive power at different axis, correct with cylindrical lens

aging related impaired accommodation (focusing on near object)

due to ↓lens elasticity, changes in lens curvature, ↓strength of the ciliary muscle

risk factors: age, smoking, alcohol, sunlight, corticosteroid, diabetes, trauma, infection; galactosemia, galactokinase deficiency, trisomies, ToRCHeS infection, Marfan syndrome, Alport syndrome, myotonic dystrophy, NF2

painless, often bilateral, opacification(混濁) of lens→glare(まぶしさ), ↓vision

optic disc atrophy with characteristic cupping (thinning of outer rim of optic nerve head), usually with elevated IOP and progressive visual field loss

primary-cause unclear; secondary-blocked trabecular meshwork from WBCs, EBCs, retinal element

acute closure: emergency, halos(光輪) around lights, frontal headache, fixed and mid-dilated pupil; mydriastic agent contraindicated

secondary-hypoxia from retinal disease induces vasoproliferation in iris that contracts angle

primary-enlargement or anterior movement of lens→obstruction of normal aqueous flow through pupil→fluid build up behind iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork

degeneration of macula, cause distortion and eventual loss of central vision

deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium with ↓ vison

rapid loss of vision due to bleeding 2° to choroidal neovascularization

treatment: prevent progression with multivitamin and antioxidant supplements

damaged capillaries leak blood→hemorrhage and macular edema; treat with blood sugar control

chronic hypoxia→new blood vessel formation; treat with peripheral retina photocoagulation, surgery, anti-VEGF

flame-shaped retinal hemorrhage, arteriovenous nicking(網膜動静脈血管狭窄), microaneurysms, macular star, cotton-wool spot

retinal hemorrhage and engorgement(充血) (blood and thunder appearance) , edema

blockage of retinal vein due to compression from nearby arterial atherosclerosis

separation of neurosensory layer of retina→degeneration of photoreceptors→vision loss (due to retinal break, diabetic traction, inflammatory effusion