NEUROLOGY REVIEW For those who still suffering from Neuro …

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diffuse cognitive dysfxn 2 www. sleep paralysis. headache. dextroamphetamine). environment. abrupt onset & end. dementia. stimulants. blank stare. w/ peripheral neuropathy. sleep instructions. large tonsils or palate. periodic limb movement disorder. MAO-I. delayed sleep phase syndrome. stroke atonia like REM sleep -> intrusion of REM sleep into wakefulness Obstructive sleep apnea syndrome narrow airway (blockage by tongue. depression. bronchodilators. prevent injury not paralyzed during REM -> act out dreams. often nocturnal or upon awakening. post-ictal blindness if secondary to TLE or FLE often misdiagnosed as psychogenic seizure Parietal lobe epilepsy Occipital lobe epilepsy Idiopathic Generalized Childhood Absence epilepsy Juveline Absence epilepsy Juvenile Myoclonic epilepsy Symptomatic/ cryptogenic Generalized Lennox-Gastaut syndrome onset age 2-10 onset after puberty onset in adolescense. myalopathy. uvula) loud snoring . EtOH withdrawal Epilepsy Idiopathic Partial Benign Rolandic epilepsy onset age 2-13. no post-ictal state aura of epigastric rising (nausea). frequent. AD inheritance w/ incomplete penetrance absence seizures. pharynx. Tx = valproate benign many types of seizures. can be induced by hyperventilation usu. induced by hyperventilation tonic-clonic seizures. pain meds. often in developmentally disabled. narcolepsy. vertigo visual hallucinations. emotion/laughter). antidepressants. irritability. early adults brief. w/ Parkinson's. pregnancy. Fe-deficiency mosr common in 1st 1/3 of night (delta NREM) in children w/ family Hx during stage 3-4 of NREM unexplained fright upon awakening different every time sleepwalking vague memory of impending doom avoid precipitants. triggered by stimulants (Ritalin. psychic phenomena. no impairment of consciousness. restless legs. memory probs genetic (HLA-DR15 ). frequent arousal at night. lack of abnl REM (Dx: incr. hypnagogic hallucinations. remits by 18 less remission does not remit. medical causes difficulty falling asleep or staying asleep hypnotics. psychophysiologic insomnia inadequate sleep hygiene. MI. benzodiazepines Restless legs syndrome Parasomnias NREM arousal disorders Somnambulism Sleep Terror REM sleep behavior disorder Nightmare assoc. meds. drooling. assoc. stress. nocturnal clonic facial twitching. tricyclic ADs for Dx: multiple sleep latency test cataplexy urge to move legs while sleeping dopamine agonists. remits by 18 benign Symptomatic/ cryptogenic Partial Frontal lobe epilepsy Temporal lobe epilepsy brief (seconds). EMG). micrognathia. violent or injurous behavior during REM atonia. retrognathia. steroids). w/ . excess sleepiness. disinhibition of brainstem centers vivid memory of scary dreams (during REM) full alertness upon awakening assoc.Condition Sleep Disorders (dyssomnias) Intrinsic Extrinsic Circadian rhythm disorders Insomnia Pathogenesis Sx / Dx Rx Notes obstructive sleep apnea. EtOH. lip-smacking aura of somatosensory Sx. linked to orexin deficiency Narcolepsy cataplexy (sudden loss of postural tone while awake. blank wide-eyed stare & dilated pupils. weight loss risk Fx: obesity. insufficient sleep. exacerbated by sleep deprivation usu. narcolepsy. no post-ictal confusion. agitated hypermotor behavior. hypnotic sleep disorder shift work. infrequent morning myoclonic seizures. surgery. idiopathic hypersomnia.brain101. advances sleep phase syndrome drugs (caffeine. sleep restriction CPAP (continuous positive air pressure). begins/ends abruptly.

carotid endarterectomy if severe stenosis 7099%. repeat expansion on chrom. rotenone). resembles dystonic cerebral palsy w/ diurnal variation late onset. no CNS degeneration or damage. aprosody contralateral hemiparesis (leg > face/arm) & sensory loss. acute Tx: t-PA if onset w/i 3 hrs & no hemorrhage on CT Stroke Internal Carotid Middle Cerebral transient monocular blindness (ophthalmic a. rigidity. agraphia. 3) evidence function mutation -> deposits in striatum projection of progression. behavior problems are disabling. dysarthria. late: dementia. ex. unilateral. Lewy bodies on histo aging or environmental toxin exposure (ex. pyramidal/cerebellar origin (excess activity) usu. denies loss of vision) ipsilateral CN defects. antiplatelets. anti-coags. masked facies. of dopaminergic neurons from substantia nigra micrographia. older pts w/ chronic use of dopamine antagonists (schizophrenics) multiple motor or phonic tics (most common in face/eye) one-sided involuntary jerking of proximal limb fixed posture of limbs dystonic hands/face. visual hallucinations. voice is affected involuntary dyskinesia of oral/buccal mucosa (lip-smacking) β-blockers (inderal).brain101. vertigo. tyrosine hydroxylase mutation. onset age 30-40 childhood onset. chorea . abulia/akinesia = no affect (Acomm). stress/anxiety. late: balance probs. other neurodegenerative dz (distinguish by doparesponse). drug-induced (neuroleptics. (no surgery if stenosis < 50% ). visuospatial difficulty. MPTP -> MPT+ -> mitochondrial damage. strong excitotoxic hypothesis (NMDA -> Glu). cortical blindness if bilateral (pupils respond to light. 4) exclusion of treatable dz neurons (regional selectivity) -> striatal atrophy. early: shuffling gait. age-related loss of VMAT2 hypokinetic clinical syndrome due to degeneration resting tremor . contralateral visual field defect (if posterior). flexed posture. non-dominant -> neglect. 1/3 same. CAG triplet early: personality change. Dx: response to dopa. Kayser-Fleischer rings on cornea. tremor. 4 (anticipation). dysarthria. compensation for striatal neuronal loss = decr. Dx: 1) family Hx. rigidity . urinary incontinence contralateral visual field defect. orthostasis. dominant -> aphasia. onset age 40-70 hyperkinetic . Dx: urine Cu dystonia Huntington's disease DNA test -> carrier (not Dx of disease). ex) Wallenburg (PICA) lateral surface Anterior Cerebral medial surface Posterior Cerebral posterior brain Vertebrobasilar brainstem 3 www. rigidity. . 1/3 lose response) Notes Diff Dx: essential tremor (only Sx). stereotypic. ipsilateral cerebellar Sx. altered consciousness. often assoc.Condition Movement Disorders Parkinson's disease Pathogenesis Sx / Dx Rx L-dopa (1/3 improve. not tics anti-cholinergics primary types = full body (childhood onset). may be accelerated dementia. movement. DA clearance. 2) movement disorder. anti-emetics). ipsilateral gaze. embolus) contralateral hemiparesis (face/arm > leg) & sensory loss. autosomal dominant. antiHTN. w/ ADHD or obsessive/compulsive disorder destruction of subthalamic nucleus -> same common pathway as HD destruction of putamen autosomal recessive copper transport disease rare. bradykinesia . child onset. abnl eye mvmts. contralateral hemiparesis & sensory loss. primidone limit doses of neuroleptics prevention: modify risk Fx. gain of athetosis. weak excitotoxic hypothesis Tourette's syndrome Hemiballismus Dystonias Wilson's disease Dopa-responsive dystonia dopamine antagonists tics may be predictable. dystonia. focal-segmental type (adult onset) L-dopa (very responsive entire life) Essential tremor Tardive disorders postural/kinetic tremor = amplified by extended posture. pars compacta to putamen.

cerebral angiography curative = surgical clipping (low rebleed = highest risk w/i 24 hrs. amyloid angiopathy (Alzheimer's) due to rupture of berry aneurysm (congenital. PMNs. risk Fx = amount of invasive) blood in SA cystern Traumatic injury Epidural hemotoma (EDH) skull fracture & rupture of middle meningeal a. peak age 40-49 sentinel headache ("worst headache of my life"). rupture = Acomm > "worst headache of my life" 30%. vasculitis. hemorhagic diathesis (thin blood).. acquired aneurysm (atherosclerosis. pyknotic glia. thalamus.brain101. family Hx of epistaxis or multiple AVMs large vascular channel. blood or xanthochromium in CSF). basilar (SCA) 10%. at bifurcations. supratentorial cavernoma -> temporal lobe seizure. C1 of hippocampus. followed by infarct. internal capsule. usu. nausea/vomiting. 5-point star). 30% assoc. vessel proliferation. meningismus. Dx: CT (95% sensitive. fusiform). saccular). usu. 50% w/i 6 mos. rupture -> subarachnoid hemorrhage forms bleb. pyknotic glia. MCA 20%. pons.Condition Ruptured Aneurysm Saccular (berry) Pathogenesis Sx / Dx Rx Notes congenital defect in vessel wall -> weakness mass effect -> compress brain or CN III. caused by thrombosis. low pressure. lymphs/macs. pyknotic glia. Pcomm (ant. lymphs/macs. thin-walled from high BP. hypoxic or ischemic encephalopathy pink neurons. gyri flattened. astrocytic gliosis (scar forever). etc. photophobia. astrocytic gliosis pink neurons. often in basal ganglia . -> blood separates dura from periosteum (not a real space) -> compresses brain rupture of bridging veins -> blood separates dura from pia mater. vasospasm = peak 4-14 days post-SAH. choroidal) 25%. can herniate usu. Dx: CT. neoplasm. vertebral (PICA) 5% atherosclerotic disease caused by infection (IVDA or endocarditis). brain has shrunk -> mild trauma can cause SDH Subdural hematoma (SDH) Vascular malformation Hypertensive cerebrovascular disease Charcot-Bouchard microaneurysms Lacunes small vessel out-pouchings. neuro deficit. at circle of Willis. may rupture tiny infarcts of penetrating arterioles. incidental bleed = recurrence) & endovascular coiling (less 1% /yr. neuropil edema. radiosurgery (focus on nidus) if deep in brainstem or basal ganglia Osler-Weber-Rendu syndrome Cavernous (cavernoma) Venous Capillary Telangiectasia Ischemia & Infarct Global Cerebral Ischemia Focal Cerebral Ischemia Ischemic infarct Hemorrhagic infarct usu. brainstem surgery : remove symptomatic cavernoma more symptomatic (neuro deficit) than AVM cavernoma from brainstem no bleeding risk no bleeding risk brain swollen. cavitation Incomplete infarct selective necrosis of neurons w/ preserved glia Hemorrhage Intracranial Hemorrhage Intraparenchymal hemorrhage Subarachnoid hemorrhage (SAH) due to hypertension . peak age 10-19 AD. less bleeding risk. atherosclerosis caused by focal ischemia due to thrombosis. neuropil edema. seizure 25%. vessel proliferation. cerebellar Purkinje cells cannot remove surgery if superficial. dead tissue + blood in parenchyma pink neurons. PMNs. cerebellum wide perivascular space filled w/ macrophages many TIAs cause multi-infarct dementia disease of small vessels of white matter (leukencephalopathy) thick acellular vessel wall starch bodies Etat crible Hypertensive encephalopathy Binswanger disease Hyalinized arteriolar sclerosis 4 www. neuropil edema. venous hemorrhage -> develops slowly see above in older people. headache 10-20%. angiography (early draining vein ) bleeding of nasal mucosa & lung parenchyma less severe bleed. brief syncope. 3rd layer of . respirator brain selective vulnerability = neurons > glia > neuropil. w/ venous malformation caput medusae hemorrhage 50%. lumbar puncture (if negative CT. usu. embolus. in periphery at cortical surface (not at CoW) Fusiform Mycotic Vascular Malformations Arteriovenous (AVM) tangle of vessels (nidus) w/ fistulous connection to vein -> high venous pressure.

progressive weakness. dye injected into lateral ventricle recovered in lumbar space obstructive ventricular blockage unequal dilation of ventricles. systemic disease. postsynaptic Ach receptor . & frontal balding. ESR . impaired CSF absorption equal dilation of all ventricles & subarachnoid space. venous pressure (HF. Paget's disease Non-communicating Neuromuscular disease Myasthenia gravis often paraneoplastic autoimmune antibodies vs. low EPP. Dx: edrophonium. acetazolamide complications = blindess. low EPP. Dx: incr.. LP for Dx & Tx obese/pregnant women triggered by chewing. daily pts. MELAS Chronic steroid Acute steroid Infectious Rhabdomyolysis risk Fx = nutritional defic. variable duration.Condition Headache Migraine Tension Cluster Pathogenesis Sx / Dx unilateral > bilateral. EMG = repetitive firing most treatable autoimmune autoimmune. AVM). atrophy of temporalis m. sepsis. severity varies over hours…yrs. renal failure. cyclical (often daily). proximal > distal distal predominance of hands assoc. injected dye can't be recovered in lumbar CSF space affects skeletal muscle only ptosis. cognition. trinucleotide repeats -> anticipation. w/ abnormalities of endocrine. intense unilateral pain. muscle contraction short duration (30 min). aura. in young boys X-linked. heart. normal MEPP. can't sit still TMJ disease Temporal arteritis systemic vasculitis in older people headache. papilledema. presynaptic voltagegated Ca-channels Myopathies Congenital Dystrophy Duchenne muscular dystrophy Becker muscular dystrophy Myotonic dystrophy Inflammatory myopathy Polymyositis Dermatomyositis Inclusion body myositis Metabolic myopathy Mitochondrial myopathy Myopathy of systemic disease maternal inheritance . nausea. sensation & reflexes named after biopsy findings. hemorrhage (SAH. lipid. TPE. Ach release (improved by rapid repetitive stimulation -> more Ca in end-plate) causes = . normal muscle bulk. stroke Pseudotumor cerebri Trigeminal neuralgia aka benign intracranial hypertension. often frontal. steroids (common iatrogenic). fat build-up in muscle "energy crisis" under excess stress. aching/tightening. w/ malignancy. put hand to cheek Hydrocephalus Communicating extraventricular blockage. fever. easy fatiguability. CNS. chronic headaches. cold sharp unilateral lancinating pain. assoc. incr. colchicine normal EMG & CPK steroid + NMJ blocker = loss of myosin (acute quadriplegic myopathy) trichinella or HIV severe muscle injury myoglobinuria pain on exertion (myalgia). non-progressive inherited & progressive weakness severe proximal muscle weakness. remove tumor. painless. affects CNs Lambert-Eaton Myasthenic Syndrome (LEMS) autoimmune antibodies vs. usu. lightheadedness. lacrimation. rash on knuckes & eyelids weakness in quadriceps. jaw claudication. alcohol (binge -> rhabdomyolysis). impotence. cumulative steroids 5 www. MEPP. smoking pts. photophobia. w/ other autoimmune disorders & thymus (thymic hyperplasia. difficult eye mvmts & holding head up. pseudohypertrophy of calf musc. assoc. throbbing/pounding bilateral. polymyalgia rheumatica = malaise. syndromes = KearnsSayre. transverse smile. idiopathic. visual probs. thymoma ) assoc. non-treatable flattened folds in NMJ indicate loss of Ach receptors and AchE. low therapeutic plasma exchange (TPE). abnl use of glycogen. SDH). thyroid. AZT (ragged-red fiber). wrist & finger flexors . tumors of aqueduct. posterior fossa malformation. biopsy = ragged-red fibers (clumping mitochondria). usu. absence of dystrophin . found in kids X-linked. testicular atrophy peculiar build or muscle weakness. in adults myotonia = stiffness . dry mouth. long-thin face. pyridostigmine. but extensors still strong steroids steroids no steroid response proximal > distal assoc. low [Ach] immunosuppression symmetric. normal [Ach] immunosuppression weakness of proximal muscles (pelvic girdle). eyes. decr.brain101. joint steroids (for years) pain. polyneuropathy. often in young elev. assoc. w/ small cell carcinoma of lung. statins. trauma. unilateral Horner's syndrome bilateral aching. extraaxial tumor causes = congenital aqueduct stenosis. found in adults usu. ICP may be mildly elevated. CT disease probably autoimmune lymphocytes invade muscle -> breakdown vascular involvement. low levels of dystrophin . anorexia. TMJ dislocation Rx abortive (relief) or prophylactic (prevention) drugs Notes O2 mask. oxygen adrenal (excess steroids). esp. histo: flat NMJ folds. avoid EtOH. proximal muscle weakness . parasthesia. biopsy (giant cell in lumen) steroids. in older boys AD. thymectomy. CSF pressure.

large pyramidal cells in hippocampus neurons vulnerable. risk Fx = duration. gradual progression. ankle weakness (chronic progressive). may be segmental. symmetric diffuse weakness . hammer toes. esp. rapidly progressing weakness (legs to arms). most common neuropathy in U. no incontinence post-polio syndrome = worse mobility later in life only motor fibers affected degeneration of UMNs & LMNs (anterior horn cells hyperreflexia . globus pallidus thiamine (B1) deficiency (esp. esp. diffuse. affects occipital lobes beta INF doesn't help aka globoid cell leukodystrophy 6 www. mild sensory Sx symmetric involvement of large nerves (motor & sensory) -> distal & proximal weakness. areflexia. abnl CSF findings (high protein.brain101. glia. combined UMN & LMN signs -> ankle areflexia w/ upper extremity corticospinal tracts hyperreflexia leads to conduction block. blue balls of myelin accumulation of . esp. areflexia pes cavus . VII. no & corticospinal tracts) incontinence bilateral symmetry & selective vulnerability gray matter neurons vulnerable.S. VI). reflexes in one or more limbs. supporting cells vulnerable (capillaries. maybe fasciculations.Guillan-Barre syndrome Chronic inflammatory demyelinating neuropathy (CIDP) Hereditary motor sensory neuropathy type I (HMSNI) Motor Neuropathies Polio Amyotrophic lateral sclerosis (ALS) Lou Gehrig's disease Pathogenesis Sx / Dx Rx Notes EtOH -> paresthesia (burning. alcoholic cerebellar degeneration -> anterior vermis atrophies Toxic/Metabolic diseases Global hypoxia Carbon monoxide poisoning Wernicke's encephalopathy Hepatic encephalopathy swollen astrocytes (Alzheimer type II glia) bilateral symmetry + selective vulnerability + axonal sparing + abnormal deposits Toxic/Metabolic & Demyelinating diseases Central pontine myelinolysis Subacute combined degeneration Krabbe's disease Metachromatic leukodystrophy Adrenoleukodystrophy caused by rapid overcorrection of hyponatremia -> vacuolar demyelination vitamin B12 deficiency (pernicious anemia) inherited deficiency of β-galactosidase inherited deficiency of arylsulfatase X-linked axons spared affects motor tracts (corticospinal) and sensory tracts (dorsal columns).Condition Peripheral Neuropathies Axonal Neuropathies Hereditary motor sensory neuropathy type II (HMSNII) Diabetic neuropathy Vit B12 deficiency Demyelinating Neuropathies Acquired inflammatory demyelinating neuropathy (AIDP) . thin legs gradual onset (> 4 wks) rapid progression weakness usu. associated retinopathy & nephropathy subacute combined degeneration of dorsal columns. tingling of feet) = progressive painful sensory neuropathy inherited. in mamillary bodies & aqueduct astrocytes vulnerable. normal sensation. in deep gray matter cavitation & gliosis if old carboxyhemoglobin -> pink brain neurons spared. III. flaccidity. alcoholics). sensation in lower extremities glycemic control. loss of reflexes does NOT depend on gender or type of diabetes. CN involvement (esp. affects white matter tracts accumulation of LCFAs. decr. distal > proximal degeneration of LMNs (nerves & anterior horn cells) aka Charcot-Marie-Tooth disease weakness (leg>arm). IV. in macrophages accumulation of sulfatides. lower extremities affected before upper pes cavus (foot arching). lipids accum. esp. or secondary acute onset Hx of recent flu-like illness (antecedent infection). no cells). poor symmetric numbness & decr. myelin). slow progression.

dancing feet" 7 www. polygenic inheritence. hypoxic = perinatal asphyxia) doesn't reach milestones at normal time static = slow acquisition of milestones. SGE hemiplegia/quadriplegia). Dx by MRI (T2 plaques). decr. EAE animal model. N. w/ small occult neuroblastoma truncal ataxia w/ or w/o extremity tremor or nystagmus opsoclonus = rapid chaotic eye mvmts (persists in sleep). selflimited acute. astrocyte proliferation. contractures. unknown = schizencephaly). thin ribs. smallpox vaccine. impaired transmission in CNS. or 2) injury to normal brain (metabolic = hypoglycemia. perivascular distribution. cortical encephalopathy (irritability +/dementia) rule out EtOH/dilantin intox. rapidly progressive -> often die w/i 1 year triggered by rabbit rabies vaccine. benign. Sx: subacute dementia. Dx: Hx of 2 diff. toxic = fetal alcohol syndrome. fatigue. high diaphragm. protozoa fungi & TB affect base of brain temporal lobe destruction post-measles Creutzfeld-Jacob disease (due to prions) coalesced macrophages pus in subarachnoid space collagen walls off abscess nodules of giant cells abscess or pseudocyst filled w/ toxoplasma mucor causes hemorrhage massive hemorrhagic necrosis & inflammation inclusions in gray & white matter Kuru also caused by prions Pediatric Neurology Development delay Static global encephalopathy (SGE) can be global or localized due to 1) brain malformation (genetic = Down's. lumbar puncture (oligoclonal antibody bands -> not Devic's syndrome) Infectious diseases Herpes encephalitis Subacute sclerosing panencephalitis Spongiform encephalopathy HIV encephalitis Bacterial meningitis Abscess Granuloma Toxoplasma due to E. areflexia. rubella. intrathecal Ig (in CSF). autoimmune vs. muscle (congenital myopathy. irregular (not bilateral symmetric) sclerotic plaques of periventricular areas (corpus callosum).brain101. radiation exposure. strep B). face not affected). Guillan-Barre syndrome "dancing eyes. CMV) or post-natal (E. H. transient myasthenia gravis). inclusion bodies patchy. rapidly progressive. abnl motor control (weakness. fungi. urinary urgency. progressive = loss of milestones Cerebral Palsy static motor encephalopathy . damage by TNFα. coli. meningitidis. hypothyroidism. oligodendrocyte degeneration (naked axons). maternal PKU. CNS = same etiologies as SGE floppy baby -> no resistance to passive motion. spinal cord lesions cause more Sx than brain lesions most common cause of nontraumatic disability in young adults (18-60). infectious = congenital (toxo. course = relapsing/remitting. Sx: intranuclear ophthalmoplegia. often in AIDS pts at least 2 lesions in CNS separated by space & time. face affected). can be post-infectious. ataxia. CNS myelin. lethargy. but 50% assoc. Sx = cerebellar ataxia. CNS = . measles virus JC papovavirus infects oligodendroglial cells multifocal lesions of white matter. transverse myelitis . coli. S. do NOT treat w/ gamma INF -> worsens Sx. Fragile X. 50% need cane 15 yrs post-Dx. influenzae. acute flare: IV steroid (solumedrol) Progressive multifocal leukoencephalopathy Multiple sclerosis almost always fatal. evoked potentials (visual most commonly abnl). NM jxn (infant botulism. myoclonus = shock-like muscle contractions. optic neuritis. later. same etiologies as hypotonia in early infancy. unilateral > bilateral. Copaxone -> reduce relapse & number of lesions. macrophages accumulate fat. linear lesions along veins.Condition Demyelinating diseases Allergic encephalomyelitis Pathogenesis myelin or oligodendrocyte is target Sx / Dx axonal sparing & abnormal deposits Rx often in AIDS pts Notes acute disseminated. PNS = weakness. pneumoniae due to bacteria. no weakness static = damage has already been done Hypotonia Acute ataxia Post-infectious cerebellar ataxia Opsoclonus/ Myoclonus syndrome acute onset follows viral illness (chicken pox). not progressive or global PNS = anterior horn cells (Werdnig Hoffman. CNS events (supported by exam) or Hx of 1 CNS event w/ positive lumbar puncture prophylaxis: beta interferon = Avonex. glial cells filled w/ virions. myotonic dystrophy. posterior fossa tumor. T-helper fxn. fasciculations. spastic tone. incr. T-suppressor fxn & incr. perivenular inflammation. William's. Betaseron. symptomatic therapy to control spasticity.

radiation. extra ch. myeloma surgery curative (often lose hearing. usu. discrete margin survival < 1 year more mitoses & pleomorphism. usu. GH. diffuse low-grade astrocytoma grade III grade I. w/ Epstein-Barr virus generally benign. palsy) tumor of vestibular schwann cells of CN VIII in posterior fossa.brain101. at gray-white jxn (high local blood flow). lobules. assoc. medulloblastomas) infiltrate & kill. leukemia Carcinoma Colloid cyst Pituitary adenoma grade IV grade I grade I. etiology = trauma. meningiomas) externally compress. endocrinopathy (prolactin. tumor compresses but does not infiltrate. diffuse type NHL (B-cell). not curative brain. ICP. no surgical cure (only symptomatic parenchymal. often occurs in corpus callosum. kidney. EMF exposure. lymphoma. endocrine responsiveness (progesterone receptors . 10 Astrocytoma Anaplastic astrocytoma Pilocytic astrocytoma Glioblastoma multiforme Ependymoma Oligodendroglioma Ganglion cell tumor Undifferentiated tumors Medulloblastoma GFAP = glial fibrillary acidic protein surgery usu. Cushing's. usu.Condition Brain Tumors Pathogenesis neural tube (gliomas. EGFR amplification. thickening -> conehead). generally benign. focal deficits. 7 and deletion of ch. disseminate throughout CSF grade II. MRI: sella enlargement. primary tumors usu. fatal . Sx = incr. 22 mut) variable presentation. distinct margin location = 3rd ventricle Sx = mass effect. acromegaly). bilateral = NF2 (both ch. also melanoma. more common in women. 17) grade IV. neural crest (schwannomas. unilateral = sporadic. breast. Homer Wright rosettes (fibrillar. chemo. perivascular rosettes (fibrillar zones around vessels) perinuclear haloes . progress to high grade over time. spine pain. thyroid. LOH ch. generally benign. adults 8 www.. high N:C ratio. Sx = incr. ICP. infiltrate. Dx: MRI. GFAP (+) Sx / Dx Rx Notes MIB-1 (antibody for Ki-67) stains proliferating nuclei Gliomas surgery prolongs life.hydroxyurea. seizures. Rosenthal fibers butterfly lesion crosses corpus callosum. seizures. in immunosuppressed pts (AIDS. carcinogen. monotonous. p53 mutations. Antoni A & B patterns axons through tumor -> infiltrates peripheral nerve often multiple lesions . immunotherapy incidence rising. immunoperoxidase stains pituitary peptide hormones etiology = hypothalamic stimulation of pituitary. 22. multiple endocrine neoplasia parenchymal lesions = lung. transplant. RU486. XRT headach. syncytial . maintained basement membranes. but does not invade . radiation. blue tumor. whorls (like granulomas). breast. CT: contiguous w/ ventricular or meningeal surface of XRT & chemo extend life. TSH. blue tumor = nuclear crowding. XRT. XRT adjunct. compresses CN VIII . 10 grade II-III grade II-III neoplastic neurons prognosis by MIB-1. bony lesions = prostate. either endothelial proliferation or necrosis (palisades) luminal rosettes (cilia project into lumen). spinal bony or epidural = pain & cord compression. SV40 papovavirus Meningioma attached to dura. etiology = trauma. deletion or LOH on ch. Neurofibroma Metastatic tumors NF1 (ch. IFNα > enlarges during pregnancy). psammoma bodies (laminated calcifications) NF2 = neurofibromatosis 2 Nerve sheath tumors Acoustic neuroma (schwannoma) grade I. recur despite therapy. hydrocephalus. hyperostosis (bone surgical resection. lung. basal ganglia. posterior fossa. posterior fossa spreads rapidly. GFAP (+) looks like hair cell . juvenile astrocytoma grade . monoclonal staining of B cells Primitive neuroectodermal tumor (PNET) grade IV Primary CNS lymphoma (PCNSL) grade IV. Dx: MRI epithelial appearance. CN palsies. collagen vascular dz). metastases internally or externally compress occur anywhere in CNS. G-protein mut. subarachnoid = relief). focal deficits . ACTH. nested indistinguishable by histology alone (need location) grade IV arises in cerebellum . usu. no lumen) non-cerebellar origin uveocyclitis . not a cure. facial n. arise from arachnoidal cap cells. Verocay bodies (alternating nuclei/fibrils).

painless painless sudden loss of vision. pus pocket in eye floaters. retina looks pale/milky (thickened) painless. over age 60) painful loss of vision. due to sungazing (burned fovea). ptosis) not capable of suppressing eye capable of suppressing eye (not fully developed). pulls on retina thrombosis or embolus of retinal artery arteriosclerotic occlusion or temporal arteritis (usu. blurry vision. lens system too powerful eyeball too short . decr. refer to ophthalmologist. decr. red eye. pernicious anemia. stroke. swollen disc Refractive Conditions Emmetropia Myopia (nearsighted) Hyperopia (farsighted) Astigmatism Presbyopia perfect eyes eyeball too long .Condition Visual Field Defects Optic nerve defects Central scotoma Pathogenesis Sx / Dx Rx Notes defect of papillomacular bundle. detected by leukocoria (white pupillary reflex) binocular . due to optic nerve infarction. no hypophorias diplopia (foveas not focused on same object) monocular (one non-fixating eye) Phoria Amblyopia Acute Persistent Visual Loss (emergencies) Keratitis Acute angle-closure glaucoma Endophthalmitis Retinal detachment Retinal artery occlusion Ischemic optic neuropathy inflammation of cornea. image recognition dark spot in center of vision Cecocentral scotoma Arcuate scotoma Temporal wedge scotoma Chiasmal defects Bitemporal hemianopia Retrochiasmal defects Complete homonymous hemianopia Incongruous hemianopia Congruous hemianopia Integrative defects central scotoma connected to physiologic blind spot (elongated oval shape) defect on opposite side from retinal lesion respect horizontal meridian border vertical meridian but never cross nasal field affects contralateral visual field (ipsi temporal retina + contra nasal retina) loss of entire half of visual field lesions not identical in both eyes lesions exactly same in both eyes parietal = peripheral movement respects vertical meridian Eye Deviations Strabismus Tropia Adult tropia Childood tropia ocular misalignment constant deviation of visual directions due to CN palsies. blurry vision. cover-uncover -> eye drifts out of alignment reduced vision b/c of visual cortex suppression of retinal image . eye strain. inflammation usu. astrocytoma. radiations. accomodative esotropia. poor distance vision concave (diverging) corrective lens (-) normal distance. mets to liver & brain. anisometropia. degeneration. due to congenital anomalies. toxins. trauma infantile esotropia. iatrogenic vitreous changes w/ age. don't cause amblyopia. often due to HSV painful loss of vision. tumor compression defect of papillomacular bundle defect of arcuate bundle. subepithelial scar corneal graft laser hole in iris to reduce IOP drain reattachment surgery lower IOP high dose corticosteroids usu. afferent pupil defect. or visual cortex total lesion subtotal lesion in optic tract subtotal lesion in visual cortex temporal = fine details. also adult causes transient deviation of alignment -> eyes held in alignment by fusion due to tropia. no change in visual acuity at first foreign body sensation blocked exit of aqueous humor by canal of Schlemm sudden severe painful loss of vision. malignant. meningioma.brain101. flashes of light. incr. lens stiffens & less elastic difficulty reading normal reading. cherry-red spot . carotid aneurysm damage to optic tract. LGN. may lead to amblyopia . visual deprivation. red eye. tumor. corneal opacity. in periphery. damage to temporal visual field due to pituitary tumor . craniopharyngioma. childhood exotropia. red eye. formed in childhood patch normal eye to force use of nonfixating eye may indicate underlying retinoblastoma -> AD. red reflex. accomodation helps vision (may not have Sx until convex (converging) corrective lens (+) later in life) cylindrically curved corrective lens bifocals contacts don't work well hyperopic people become presbyopic at younger age 9 www. lens system too weak abnl curvature of cornea normal loss of accomodation w/ aging . sepsis. myasthenia gravis. visual deprivation (cataract. treat early to depth perception prevent amblyopia (tropias don't disappear w/ time) Sx = headache. optic neuritis. intraocular pressure infection. Graves. poor reading. glaucoma defect of nasoradial bundle. due to .

exposure keratitis sudden painless loss of vision. macular edema . congenital. usu.Condition Other Eye Disorders Cataracts Pathogenesis any opacity in lens . photophobia. ciliary body). discomfort. lid retraction. cortex. headache. trauma. tearing swelling. episclera. CMV retinitis zoster ophthalmacus. redness. retinal hemorrhage hyperthyroidism. ecchymoses vision loss. good visual acuity. may lead to blindness Primary open angle glaucoma lower IOP (meds. vision OK pain. in IOP. CN palsies. causes = age-related. surgery) Red Eye Emergencies Orbital cellulitis Orbital tumor Keratitis Uveitis Acute angle-closure glaucoma Endophthalmitis Bacterial conjunctivitis swollen eyelid. tenderness. Kaposi sarcoma. exophthalmos . microaneurysms . tearing. ptosis proptosis ciliary flush (red halo). photophobia. orbital swelling. neovascularization. usu. goiter. foreign body sensation. pupil looks oval (swollen iris) auto-immune iris plugs trabecular meshwork infection inside eye purulent discharge . nodules in sclera. sudden incr. scleritis. optic nerve edema. abnormal light reflex vitreous hemorrhages. arcuate defects. etc treponema pallidum "-itises" of the . radiation (NOT glaucoma) trabecular meshwork outlet pores too small -> cupping of optic nerve w/ incr. drops. ulcerative keratitis lubricants cotton wool spots = ischemia of small vessels in retinal nerve fiber layer (white opacities in retina) Argyll-Robertson pupil = normal accomodation. may have permanent vision loss w/ scarred subepithelial invasion inflammation of anterior uvea (iris. Dx by Hx of painless progressive visual loss & ophthy exam cup diameter > 1/2 diameter of entire disc. pain non-opthy can repair if involves skin only and parallel to lid margin DO NOT palpate globe or evert eyelid. cotton wool spots. asymmetric earliest change is vertical elongation of cup. corneal ulcer IV ABs Dx w/ fluorescein strips. nausea. pretibial myxedema.brain101. drug-induced. toxoplasma. appear as light parts of pupil. people over 40 inflamed conjunctival vessels spread of sinus infection (from ethmoid) usu. acids neutralized quickly pain. keratitis sicca). cotton wool spots . cherry-red macula. papilledema. blurry vision hyperopes tend to have narrower angle Systemic Diseases AIDS Syphilis Diabetes opportunistic infections = CMV retinitis. etc. connective tissue Ocular Trauma Chemical burns Corneal foreign bodies Corneal abrasion Blunt ocular trauma Hyphema Eyelid laceration Laceration/penetrating injury of globe traumatic vessel rupture often overuse of contact lens alkaline penetrate eye. tabes dorsalis. inflammation. usu. retinal detachment Grave's disease auto-immune vs. may affect any layer of lens (capsule. affects blacks. photophobia. blood thinder retina AV nicking/humping. malignant (in kids) inflammation of cornea. severe pain. arteriolar spasm dry eyes (abnl tears. restricted extraocular muscle movement. IOP. Sx / Dx clouding of retinal image. corneal haze. cataracts. Argyll-Robertson pupil hyperglycemia loss of pericytes. remove Fe or Cu from eye resolves w/ anesthetic can't look up if fractured floor of orbit irrigation 10 www. most don't have visual Sx until late in disease. due to HSV. corneal epithelium denudation. tunnel vision Rx ultrasound phakoemulsification Notes everyone eventually gets cataracts. thyroid Atherosclerosis Arteriolosclerosis Rheumatoid arthritis occlusion of central retinal artery hypertension auto-immune vs. metabolic. herpes cotton wool spots. nucleus). lens thickening. glaucoma.

intracranial complications if untreated antibiotics. also meningioma. functional inner & middle ear often Treacher-Collins syndrome gradually progressive conductive hearing loss (ear looks normal) sudden onset otalgia (pain). glomus tympanicum or glomus jugulare tumors (similar to pheochromocytomas. Branhamella catarrhalis. painless surgical removal may get infected -> intermittent drainage -> often erodes incus -> hearing loss. aural fullness. furosemide. CN VII schwannoma. Pseudomonas skin carcinoma (squamous cell or basal cell). metastasis meningitis. vancomycin idiopathic disease of inner ear. foreign body. endolymphatic hypertension (hydrops) 1:4000 births. coli. purulent middle ear effusion.branchial cleft defect brief exposure to loud noise or prolonged exposure to medium noise -> outer hair cell destruction hair cell degeneration w/ aging aminoglycosides (dose-related outer hair cell death). H. AVM... E. brainstem. epidermoids. late = CN V findings. detectable by examiner not detectable by examiner may be tumor if pulsatile or unilateral fluctuating sensorineural hearing loss + episodic vertigo (2-3 hrs) + tinnitus (buzzing) often part of known syndrome early = unilateral sensorineural hearing loss. syphilis. tinnitus.steroids pain is due to eardrum distension may lead to cholesteatoma hearing loss proportional to size of perforation usu. vincristine. cisplatin. flu. red eardrum. S. aureus. HSV neuritis perception of sound w/o external acoustic stimulus pulsatile (blood flow) = vascular tumor. aeruginosa (smelly). conductive hearing loss painless conductive hearing loss. or EAC stenosis due to trauma or infection dampened vibration of tympanic membrane S. painless Otosclerosis stapedectomy (replace w/ prosthesis) Otitis externa Tumor infection of skin -> swollen obstruction ABs "swimmer's ear" Aural atresia Sensorineural hearing loss Acoustic trauma Presbycusis Ototoxic drugs damage worse at 4000 Hz damage worse at high frequencies prevention monitor dose & serum levels vestibular toxicity (tinnitus & disequilibrium) Meniere's disease Congenital loss Cerebellopontine angle & IAC lesions salt restriction. graft perforation usu. salicylates (reversible). quinine. if chronic. vinblastine. fever. proteus acquired by tympanic membrane retraction (negative pressure). Dx: MRI sudden sensorineural hearing loss NF2 if bilateral (onset by age 30) usu. serous/mucoid effusion chronic purulent drainage through perf. etc. starts in pars flaccida -> pocket fills w/ debris -> pressure on middle ear hereditary disorder of otic capsule (inner ear remodels) -> spongy bone formation near oval window -> fixation of stapes usu. pneumo. speech discrimination. tympanostomy tube ABs +/. poor eustachian tube fxn follows AOM or URI P.brain101. . but no LOC Infection Tinnitus Objective tinnitus Subjective tinnitus 11 www. hydrocephalus. pulsatile tinnitus) congenital absence of ear canal . often acquired (rubella) acoustic neuroma (vestibular schwannoma) -> compress CN V. close spontaneously. middle ear myoclonus CNS response to absence of input (hearing loss) internally generated. cytoxan.Condition Auditory Diseases Conductive hearing loss External auditory canal obstruction Tympanic membrane perforation Otitis media Acute otitis media (AOM) Chronic otitis media w/ effusion Chronic suppurative otitis media Cholesteatoma (keratoma) Pathogenesis Sx / Dx Rx Notes due to cerumen impaction. diuretics similar to seizure.

recover by 6 months. syphilitic (fluctuating or progressive) transverse fracture stapes subluxation. decr. no recovery by 6 mos. atypical if recurrent unilateral. Lyme disease. thrombus/embolus Bell's palsy (HSV neuritis. < 24 hrs vertigo labyrinthine fistula from bone erosion acoustic neuroma. no recovery. post-viral. schwannoma). diabetes. canalithiasis or cupulolithiasis also otosyphilis. herpes-zoster. neuro diseases reversible loss of smell/taste CT for mucosal dz. amyloid. cold. neoplasm (slow onset. meningioma migraine. bacterial.Condition Vestibular Disorders Acute Labyrinthine injuries Vestibular neuritis Labyrinthitis Temporal bone fracture Surgical trauma Benign Paroxysmal Positional Vertigo (BPPV) Chronic Labyrinthine injuries Meniere's disease Delayed onset vertigo syndrome Mass Lesion Cholesteatoma Tumor Vascular Disease Facial nerve paralysis toxic labyrinthitis Pathogenesis Sx / Dx Rx Notes viral lesion of CN VIII viral. facial paralysis head movement causes 20 min vertigo spell. idiopathic viral breathy weak voice inflammation -> damage to recurrent laryngeal nerve 12 . congenital steroids. potine hemorrhage. parotid tumor. mastoidectomy otoconial debris into endolymph of posterior canal. hearing loss profound sensorineural loss. slowly progressive. may have viral URI prodrome sudden onset of severe vertigo (vestibular crisis). brainstem infarction. sarcoid. sinusitis. due to voice overuse -> reactive inflammatory change limitation of singing voice (high notes). NO hearing loss. like Meniere's lasts > 20 min. facial injury). Oflactory Disorders Anosmia obstructive sinus disease (inflammation -> polyp. pregnancy. nystagmus response on repeat test) particle repositioning gradual improvement after 1 day (compensation) compensates well if unilateral hearling loss + episodic vertigo + tinnitus years after prior deafness. Hallpike maneuver (latency of eye mvmts. CN VIII compression. menstruation). incomplete closure of true vocal cords (hourglass ) nonlaryngeal malignancy. MRI for tumor Larynx Disorders True vocal cord nodules Unilateral vocal cord paralysis aka singer's nodes. neurologic (MS. MG. stapedectomy. toxins. trauma. iatrogenic (parotid or otologic surgery). GB). trauma (skull fracture. iatrogenic. perilymph fistula sudden onset of severe vertigo (vestibular crisis). allergies).brain101. anti-virals Bell's palsy has rapid onset (7-10 days).

neuronal loss in cortex & basal ganglia 30% of PD pts have dementia (esp. Dx: CT. lack of spontaneity. begins focally. Down's syndrome. sensory. age > 55. normal: α -secretase cleaves APP extracellularly to form P3 fragment & then γ-secretase (presenilin) cleaves intracelullarly to form 1. or visual loss. elderly) dopaminergic drugs worsen hallucinations mural thrombus -> emboli sudden onset. possible AD = atypical. medications (often reversible). abnormal: β -secretase cleaves APP extracellularly & g-secretase (presenilin) cleaves intracelullarly to form 1. disorientation. uncomplicated. but can reflexively). rigidity. MRI treat underlying cause Hachinski ischemia score > 4 (if 0-2. bizarre behavior. Dx: very large ventricles. pseudobulbar affect palsy (flat facial expression. startle destroyed by Chlorox (not formaldehyde or alcohol). loss of temporal-parietal cortex & primary visual cortex frontal dementia visual hallucinations . progressive. or visual cortices (like Alzheimer's) FTDP-17 (fronto-temporal dementia w/ Parkinsonism ch. low educational or occupational level. supranuclear gaze palsy (can't voluntarily move eyes.40 A β fragment. familial AD gene mutation Familial Alzheimer's disease Frontal dementia preferential anterior neuron loss in frontal behavior & personality changes (memory less affected): personal neglect.42 A β fragment Sx / Dx Sx: memory loss. no focal motor. axial rigidity (stiffness. complicated. becomes severe. fluctuation in alertness & attention. changes in behavior & personality Rx Notes Alzheimer's disease gradual progressive loss of intellect. aphasia. achromatic neuronal inclusions onset of motor Sx 1st (tremor) 1/3 have pure Lewy bodies. psychiatric illness. then probably Alzheimer's) Normal pressure hydrocephalus trauma or subarachnoid hemorrhage -> impaired absorption of CSF (no obstruction) early urinary incontinence . > mute). posterior cingulate gyrus. probable AD = typical. tactless. asymmetric rigidity . lymphatics 13 www. 17 Pick's disease Parkinsonism dementias Dementia w/ Lewy bodies autosomal dominant Tau protein mutation . swallowing probs). iatrogenic = pituitary extracts of GH Mad cow disease Isolated memory impairment prions in tonsils.Condition Dementia Pathogenesis decline of intellectual function causing altered pattern of activity w/ unimpaired consciousness. Dx: autopsy pathology cholinesterase inhibitors (tacrine. 90% sporadic (1/million/year) change & neuronal loss in cortex new variant CJD aka mild cognitive impairment . Alzheimer's) neuritic A β plaques = abnl 1-42 Aβ protein fragments (from APP) aggregate into amyloid pleated sheet. risk Fx = age. substantia nigra & cerebral cortex Lewy bodies motor Sx. nucleus basalis (cholinergic neurons) autosomal dominant. association cortex & angular cingulate cortex (Broca -impulsivity. widened sulci in frontal lobe. asymmetric apraxia (alien hand ). myoclonus . family Hx of dementia. neurofibrillary tangles = hyperphosphorylated Tau protein autoassembly. impaired visual-spatial performance. synaptic & neuronal loss = posterior temporalparietal . imbalance of Tau protein -> Tau inclusions -> focal neuron loss neuronal cytoplasmic inclusions (Pick bodies on autopsy). caused by medical illness. persistent progressive memory impairment or amnesia in person older than 50. gait problems ("magnetic " . mega-dose vit E & selegiline /denepryl inhibit free radicals in 1st 5 yrs (mild AD) usu.brain101. early seizures. memory loss is often 1st Sx. sensory. brain disease (most common. normal CSF pressure reversible if treated early Creutzfeld-Jakob disease (CJD) abnl protein = prion (self-replicating). frontal horns of ventricles odd repetitive behavior no loss of motor. hyperactive jawjerk reflex. can be rapidly progressive dementia . apraxia. spongiform 10% familial. peak age 45-60 early onset. unilateral cognitive impairments. apolipoprotein E4. preserved hippocampus (unlike Alzheimer's) multiple ethnic origins circumscribed focal atrophy cytoplasmic inclusions of α -synuclein . 2/3 have plaques & tangles like Alzheimer's loss of downgaze before loss of horizontal gaze Progressive supranuclear palsy (PSP) Corticobasal degeneration (CBD) Parkinson's disease Other dementias Multi-infarct dementia sporadic. undiagnosed in 1st year. ataxia & gait probs. focal damage (motor & reflex). donepezil) if active cholinergic neurons. bradykinesia) -> fixed neck posture mild dementia. drain ventricles of CSF mild dementia . loses 3 pts/yr on MMSE. difficulty intiating speech.can't lift foot off floor). progressive periodic discharges on EEG. normal gait & continence until late. disinhibition. enlarged perseveration = difficulty changing focus or attention. gait & incontinence problems (unlike Alzheimer's). increased risk for dementia (Alzheimer's) no impairment of everyday activity transmitted by CNS tissue or blood.

disorientation (time > place >> maintain safety 1st. genetic + environmental fx blunted affect depression or mania equal proportion of schizophrenia + mood disorder non-bizarre delusions < 1 month of Sx. directed at authority figures (at least 6 mos. minimize meds. prodrome. burn pts. occurs w/ personality disorders : paranoid.Condition Delirium Pathogenesis transient reversible cerebral dysfxn w/ acute onset & wide range of fluctuating mental status abnormalities. monitor. NOT psychiatric pts Sx / Dx Rx Notes fluctuating consciousness. cardiovascular complications.) stimulants. motor abnormalities. narcissistic. thought disorganization. onset serious rule violations hostile behavior usu. schizotypal. dysnomic aphasia. Tx w/ abnormalities. psychomotor agitation confused state. M:F = classic triad: inattention. altered perceptions. unrestrained inappropriate laughter. paralysis of external eye muscles mental retardation. boys have earlier aggression to people & animals. drug withdrawal. small size. negative Sx = SE groups. 1% lifetime risk. antidepressants behavioral therapy early onset -> worse prognosis 14 www. amnesia. school avoidance OCD often presents in children re-experience trauma autonomic arousal & avoidance fear of embarassment excessive worry discrete panic attacks schizophrenia (impaired reality) more chronic. microcephaly. impulsivity 4-9:1 antisocial types of behaviors. facial features thiamine supplements apoptotic injury reproducible w/ benzodiazepines high mortality Psychiatric Disorders Psychosis Schizophrenia Mood disorders Schizoaffective disorders Delusional disorder Brief psychotic disorder rare very common.brain101. familial. return to full level of pre-morbid fxn Substance-induced disorder Shared psychotic disorder Medical causes Child & Adolescent Psychiatry Disruptive behavior disorders Attention deficit hyperactivity disorder (ADHD) Conduct disorder (CD) Oppositional defiant disorder (ODD) Mood disorders Major depression Bipolar disorder Anxiety disorders Separation anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder (PTSD) Social phobia Generalized anxiety disorder Panic disorder Psychotic disorders rare in children. impaired mood stabilizers (meds important) psychosocial fxn dysthmia = mild form cyclothymia = mild form most common psychiatric disorder of children. treat neuro impairments = dysgraphia. M>F. ataxia. delirium tremens has fast lowthought/speech. somatic complaints. histrionic alcohol or sedative withdrawal-induced any illness may affect brain incr. attention deficit. slow diffused EEG. neuro deficits. headaches. hyperactivity. aggressive behavior extremely irritable/explosive mood. hallucinations. hyperthermia. constructional person). dopaminergic activity . cardiotomy pts. congenital heart defects. AIDS. risk groups = elderly. disorganized underlying cause. emotional haloperidol voltage EEG disturbances Alcohol Use Delirium tremens Wernicke-Korsakoff syndrome Fetal alcohol syndrome alcohol withdrawal (3-5 days) thiamine (B1) deficiency in chronic alcoholics drinking EtOH while pregnant (1st trimester) hallucinations. destruction of property. anti-HTN. malignant excessive anxiety when child leaves home or parent manifests as stomach . impaired memory. lower positive Sx = delusions. sleep-wake disturbances. usu. borderline. due to cholinergic deficits . preexisting brain dz. hyperactivity. refractory than adult prevalence jumps in adolescents may be difficult to differentiate from substance abuse or ADHD school difficulty. deceitfulness & theft.

personality. mathematics disorder. low SE classes. 1-3% of young women. F>M Dx: 15% below ideal weight. binge-purge type = overlap w/ bulimia. unconscious motivation young onset. diffusely positive ROS single symptom of acute neurological disease poor prognosis good prognosis (except if chronic) somatization = process by which person consciously or unconsciously uses body for psychological purposes or personal gain inaccurate interpretation of physical symptoms/sensations. difficulty separating from mother. hypokalemia. preoccupation or fear fair prognosis of serious illness imagined or exaggerated feelings of ugliness or concern w/ body defect pain intensity incompatible w/ known physiology. co-morbid drug abuse feigned illness w/ no obvious gains feigned illness for secondary gain poor prognosis if chronic Body dysmorphic disorder Pain disorder Factitious Disorder Malingering young adults. cultural biases. rare older onset. excess exercise Somatoform Disorders Somatization disorder Conversion disorder Hypochondriasis unconscious mechanism. dissociative. familial. unconscious motivation. low caloric intake. antisocial tendencies 15 www. rxn to stresses of adolescence. reading disorder (dyslexia). transient tic disorder won't speak in certain social situations. course = frequency) most improve w/ Tx comorbidities = disorders of mood. written expression disorder expressive language disorder. self-eval influenced by body shape. 75% impaired social interactions.. Hx of sexual abuse. occurs > 2x/week for 3 mos. course = variable nutrition support & weight gain (often secretive & resistant to treatment) comorbidities = depression. gain. conscious motivation. ego dystonic (seek & accept help). complications = Mallory-Weiss tears. chronic. often normal weight. decr. social skills normal intelligence. rumination disorder. endogenous opiates. but abnormal performance. enema.brain101. alkalosis. 510% incidence young onset. familial conscious mechanism. high suicide rate. females. . feeding disorder of infancy & early childhood Tourette's. sexual interest. w/ age after age 4 after age 5 pica. self-care. severe (IQ 25-40). phonological disorder. body image disturbances. low SE classes middle-age onset. non-purging type = fasting. chronic motor or vocal tic disorder. intense fear of weight gain. complications = bradycardia. moderate (IQ 40-55). purging type = self-induced vomiting. compensatory behavior to prevent weight psychotherapy (usu. behavior mentally retarded normal language & cognition. 1% of adolescent girls. but normal at home disturbed & developmentally inappropriate ability to relate socially repeated passage of feces into inappropriate places voiding of urine into bed or clothes "idiot savant" no delay in language or cognitive development mild (IQ 55-70). family depression. communication. epidosic multiple symptoms/complaints. Sx: antidepressants (reduce binge sexually active. & activities normal fxn for 1st 5 mos. restricting type = low premorbid weight Bulimia nervosa Dx: lack of control of eating (binge). profound (IQ < 25) Communication disorders Motor skills disorder Elimination disorders Encopresis Enuresis Feeding & eating disorders Tic disorders Selective mutism often family history Reactive attachment disorder of infancy due to severely bad parenting & early childhood Eating Disorders Anorexia nervosa etiology = hypothalamic dysfxn. impulse control. family w/ marital probs. communication. young males conscious mechanism. anxiety. regression -> severe mental retardation impaired intelligence. OCD. rapid deterioration -> death normal for 1st 2 years. anxiety. females. diuretics.Condition Continue Child & Adolesc. loss of appetite (occurs late). F>M etiology = endorphins after vomiting. Sx: rigid perfectionist behavior. M:F = 4:1. hypokalemia. (babies don't cuddle).o. amenorrhea. respond well). Hx of obesity. interests. substance use. mixed receptiveexpressive language disorder. restricted repetitive stereotyped behavior. thin culture bias. Psychiatry Developmental disorder Autistic disorder Asperger's disorder Rett's disorder Childhood disintegrative disorder Mental retardation Learning disorders only females Pathogenesis Sx / Dx Rx Notes onset < 3 y. stuttering developmental coordination disorder prevalence decr. laxatives.

info .GOOD LUCK! 16 www.brain101.

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