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Gag Reflex
CNIX (glossopharyngeal) - supplies the oropharynx, taste and senation of the post. 1/3rd of the tongue. CNIX lies in the tonsilar fossa.

Loss of Gag reflex (CN IX lesion) --> aspiration pneumonia
Blood vessels & Hematomas
1. Lesion of the MIddle meningeal artery --> Epidural hematoma.
Middle meningeal a. - lies in the interior of the lateral portion of the cranial cavity, embedded in the periosteal layer of the duar.

2. ACA or MCA tear --> blood entering the subarachnoid space (subarachnoid hemorrhage)

3. Superior Cerebral veins tear --> Subdural hematoma (blood entering the potential space between the dura and the arachnoid)
Recurrent Laryngeal nerve
_Branch of the Vaugs.
- INnervates all of the intrinsic laryngeal muscles except for the Cricothyroid muscle (inner. by Ext laryngeal n.)

Intrinsic Laryngeal muscles.
- Lateral & Posterior cricoarytenoid muscles
- Thyroaretenoid muscle
- Vocalis muscle
Jamais vu
Opp of deja vu.

Jamais vu - pt fails to recognize familiar events that have been encountered befoere.
Who doesnt belong to the Circle of Willis?
Middle Cerebral artery.
Pineal gland tumors
Compres the veertical gaze center in the tectum of the midbrain.
Pineal gland manufactures melatonin from its precursor serotonin; an inadequate supply of melatonin results in Insomnia.

Freq, the only physical sign of th etumor is Failure of upward gaze.

Tumors of Pineal gland will not compress the cerebral cortex or the rest of the Brainstem.
Empty Sella syndrome
Uncommon but dramatic condition in which the pituitary radiologically appears to be completely missing from the sella turcica which is instead filled with CSF.

- most common cause is herniation of the arachnoid thru the diaphragm sella.
- other causes include Sheehan's syndrome, surgery/radiation therapy etc.

Most pts with E S Synd have sufficient residual pituitary parenchyma to prevent hypopituitarism.
Lesions producing visual field defects
1. Central scotoma - Macula
2. Ipsilateral blindness - Optic nerve
3. Bitemporal hemianopia - Optic chiasm
4. Homonymous hemianopia - Optic tract
Hypertensive hemorrhages = Intraparenchymal hemorrhage. Site?
Basal ganglia and internal capsule - most common site.
Pupillary light reflex
Afferent limb - Optic nerve (II)
Efferent limb of the pupillary light reflex - Oculomotor nere (III; parasympathetic fibers).
Tuberous Sclerosis
A disease in which cortical hamartomas (known as Tubers) are associated with facial angiofibromas, cardiac rhabdomyomas, seizures, MR and astrocytomas.
Sxs of Increased intracranial Pressure
Acute onset headache, vomiting, nuchal rigidity & impaired mental status.

Eg: Any tumor filling the 4th ventricle blocks CSF circulation --> Increased intracranial pressure
Herpes Encephalitis
Typically affects the inferotemporal lobes and orbitofrontal gyri.
Finding: Eosniophilic Cowdry type A inclusion in neurons and glia
Post infectious Encephalomyelitis
Can follow either infection w/ measles, varicella, rubella, mumps or influenza or vaccination with Vaccinia vaccine or rabies vaccine derived from nervous tissue.

Classic pathologic finding: perivenous microglial involvement with demyelination
Angle closure glaucoma
Primary acute angle closure glaucoma occurs b/c of closure of a preexisting narrow anterior chamber angle as is commonly found in the elderly, hyperopes and Asians.
Sx: Intense ocular pain and blurred vision. "halos around lights".
Eye is red and steamy. Pupil dilated and nonreactive to light. Increased Intraocular Pressure (IOP)

Treatment: 1) Immediated lowering of the IOP with acetazolamide
2) Followed by osmotic diuretics such as IV mannitor

Acetazolamide - inhibits carbonic anyhdrase leading to reduced production of aqeous humor and a concomitant reduction in IOP.
Open Angle Glaucoma
1) Dozolamide - Carbonic anhydrase inhibitor - used for chronic lowering of IOP in pts with open angle glaucoma.

2. Epinephrine - lowering IOP in combination with mitoics, beta blockers, hyperosmotics or carb anhydrase inhibitors. CONTRA indicated in pts with narrow angle glaucoma.

3) Latoprost -

4) Timolol - beta adrenergic R antagonist that has a peak ocular hypotensive effect at 1-2 hr post dosing. decreases IOP with little or no effect on pupil size or accomodation.
Sturge Weber disease
Leptomeningeal angiomatosis
Nevus fammeus (port-wine nevus)
Posterolateral herniation of the nUcleus Puplosus
Most common herniation.
Results in the nucleus pulposus occupying space withing the intervertebral formaen.

Eg: Spinal nerve in the intervertebral foramen btw vertebrae C4 and C5 is the C5 spinal nerve.
Pick's disease
Clinically similar to Alzheimers except that the pronounced brain atrophy involves Only the Frontal and Temporal lobes.
Microscopically, affected cortex contatins 1) ballooned neurons (Pick cells) or cytoplasmic inclusions (Pick bodies).

Clinically: slow progressive dementia with language disturbances and behavioral changes.

Alzheimers: Dementia but w diffuse brain atrophy.
Normal pressure hydrocephalus
Classic triad: Memory loss, urinary incontinence, gait abnormalties --> inc ventricular pressure. --> dilation of the ventricles.

Rx: Ventricular shunt
Its a nuclear factor (of unknown function)

ITs expression is a good indicator of a neoplasm's growth rate.
Cause Anti-SLUDG i.e Decrease
- Salivation
- Lacrimation
- Urinary
- Gastric motility

Thus, cause a dry mouth (xerostomia)
A tumor in the cerebullum appearing as a cyst with a mural nodule and containing abundant Rosenthal fibers
Pilocytic Astrocytoma
Cerebellar abscesses (white rings)
Associated with Otitis Media!! (middle ear infection)
Eye and nerves
1. Oculmootor n. - eye muscles & carries PS fibers that synapse in the ciliary ganglion --> postgan PS fibers innervate the Sphincter pupillae --> Constricts the muscle.
Lesion: Ptosis & Mydriasis

2. Cervical sympathetic chain - contains preganglionic sympathetic nerve fibers, arising from teh upper thoracic spinal cord, which ascend to the Cervical sympathethic ganglia.
Lesion --> Horner's syndrome (ptosis, miosis, and anhidrosis

3. Facial n: innervates the muscles of facial expression, including orbicularis oculi muscle. Lesion --> Inability to close the eye.

4. Superior cervical ganglion- contains cell bodies of postganglionic symp nerves that innervate structures in head.
Lesion --> Horner's

5. Trigeminal n Lesion --> problem with the corneal blink reflex.

Deck Info