Question 10 Answer, Neurosurgery

Eccentric topic of the Week, Neurosurgery
Question 10 Answer:

The correct answer is E, all of the above.

Age>50, female, hypertension, smoking and genetic predisposition have all been implicated in the formation of cerebral aneurysms.

Question 9 Answer, Neuropathology

Eccentric topic of the Week, Neuropathology
Question 9 Answer:

The correct answer is C, before 2 years.

Cerebral palsy (CP) is a group of disorders characterized by loss of movement or loss of other nerve functions. Cerebral palsy is the 

result of injury to the brain during early development (before age 2). Hypoxia is the main cause of injury to the brain in CP.

Extent of motor involvement varies greatly, from a slight limp to profound paralysis, spasticity or speech problems, as well as associated disorders of learning problems, sensory deficits, and convulsive and behavioral disturbances of organic origin.
There are four main types:

Ataxic - voluntary movements are jerky; balance is lost.
Athetoid - continual muscle movements prevent or severely interfere with voluntary movements.
Hypotonic - muscles are limp, cannot contract.
Spastic - muscles are stiff; some body parts are paralyzed.

Question 10, Neurosurgery

Risk factors for the formation of cerebral aneurysms include:

1. Age
2. Female
3. Hypertension
4. Smoking
5. Genetics

A. 1,2,3
B. 1,3,4
C. 1,3,4,5
D. 3,4,5
E. All of the above

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Question 9, Neuropathology

Eccentric topic of the Week, Neuropathology
Question 9:

Before what age does a cerebral insult need to occur to cause cerebral palsy?: 

A. 6 months

B. 1 months
C. 2 years
D. 4 years
E. 6 years

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Question 8 Answer, Neurology

Eccentric topic of the Week, Neurology
Question 8:

Regarding the facial nerve:

A. A. True: It has a long loop inside the pons
B. True: It has two roots
C. False: It emerges at the ventral mid-portion of the pons
D. False: It is a pure motor cranial nerve
E. False: In Ramsay-Hunt syndrome, the upper face is spared

Answer:

The facial nerve emerges from the brainstem at the lateral pontomedullary junction as two main rootlets (the branchial motor root and the nervus intermedius). The nervus intermedius (Nerve of Wrisberg) is a mixed nerve (contains general sensory, special sensory, and autonomic).
Ramsay-Hunt syndrome produces complete palsy of a lower motor neuron type (the upper face is spared in upper motor neuron lesions). The facial nerve is paralyzed more frequently than any other of the cranial nerves.*

*Pick TP, Howden R. The nervous system. In: Gray’s Anatomy, Descriptive and Surgical, 15th edition. London: Chancellor Press, 1985: 721-725.

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Question 8, Neurology

Eccentric topic of the Week, Neurology
Question 8:

Regarding the facial nerve: 

A. It has a long loop inside the pons

B. It has two roots
C. It emerges at the ventral mid portion of the pons
D. It is a pure motor cranial nerve
E. In Ramsay-Hunt syndrome, the upper face is spared

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Question 7 Answer: Neurology

Eccentric topic of the Week, Neurology
Question 7:

Regarding the abducens nerve: 

A. True: It can be damaged in pseudotumor cerebri 

B. False: It exits from the ponto-mesencephalic junction 
C. False: Its lesion causes vertical diplopia 
D. False: It enters the orbit through the inferior oblique fissure
E. True: Its lesion is part of Millard-Gubler syndrome 


The abducens nerve exits the midbrain at the pontomedullary junction. It courses over the petrous bone and enters through Dorello’s canal. This long course makes it vulnerable to traction/compression injury in the conditions of intracranial hyper/hypotension. Its lesion does cause horizontal diplopia and it enters the orbit through the inferior portion of the superior orbital fissure. The abducens nerve is more frequently involved in fractures of the base of the skull than any of the other cranial nerves.*

*Pick TP, Howden R. The nervous system. In: Gray’s Anatomy, Descriptive and Surgical, 15th edition. London: Chancellor Press, 1985: 720. 


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Question 6 Answer, Neurology

Eccentric topic of the Week, Neurology
Question 6:

Regarding the trigeminal nerve:

A. True: It is the largest cranial nerve

B. True: It contains two roots

C. False: It carries parasympathetic fibers to the sublingual glands

D. True: Its lesion can cause deviation of the jaw on opening of the mouth

E. False: It carries the efferent elements of the corneal reflex

The trigeminal nerve emerges from the mid-lateral surface of the pons and is the largest cranial nerve. It has two components that emerge closely but have distinctly separate roots: the branchial motor and the general sensory. The trigeminal nerve forms the afferent loop of the corneal reflex. It does not carry parasympathetic fibers to any structure.*

*Fix JD. Appendix: table of cranial nerves.In: High Yield Neuroanatomy, 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 2000: 133.

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Qeustion 7, Neurology

Eccentric topic of the Week, Neurology
Question 7:

Regarding the abducens nerve:

A. It can be damaged in pseudotumor cerebri
B. It exits from the ponto-mesencephalic junction
C. Its lesion causes vertical diplopia
D. It enters the orbit through the inferior oblique fissure
E. Its lesion is part of Millard-Gubler syndrome

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Question 6, Neurology

Eccentric topic of the Week, Neurology
Question 6:

Regarding the trigeminal nerve: 
A. True: It is the largest cranial nerve 
B. True: It contains two roots 
C. False: It carries parasympathetic fibers to the sublingual glands 
D. True: Its lesion can cause deviation of the jaw on opening of the mouth
E. False: It carries the efferent elements of the corneal reflex

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Question 5 Answer, Neurology

Eccentric topic of the Week, Neurology
Question 5:

Regarding the trochlear nerve: 

A. True: It originates from the midbrain
B. True: It is the only cranial nerve that exits from the dorsal surface of the brainstem 
C. False: Its lesion results in paralysis of the inferior oblique muscle 
D. True: It supplies only one orbital muscle 
E. False: Its palsy causes horizontal diplopia 

Answer:

The trochlear nerve innervates the superior oblique muscle. Trochlear nerve palsy (weakness of the superior oblique muscle) results in torsional (palsy causes the eye to extort) and vertical diplopia; horizontal diplopia is seen in abducens nerve palsy. To compensate for the extorsion, patients with trochlear nerve palsies tilt their heads to the opposite side, in order to fuse the two images into a single visual field (by intorsion of the normal eye).*

*Snell RS. The cranial nerve nuclei and their central connections and distribution. In: Clinical Neuroanatomy for Medical Students, 4th edition. Philadelphia: Lippincott-Raven, 1997: 406.

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CDC Recommendations for Blood Pressure Control

Controlling blood pressure has to be a priority.

Why is blood pressure control so important to health?

When your blood pressure is high:

• You are 4 times more likely to die from a stroke
• You are 3 times more likely to die from heart disease

Even blood pressure that is slightly high can put you at greater risk.

Most people with uncontrolled high blood pressure:

• Know they have high blood pressure
• See their doctor
• Take prescribed medicine

To continue reading:

http://www.cdc.gov/VitalSigns/Hypertension/index.html?s_cid=fb2021&utm_source=Facebook&utm_medium=Link&utm_content=fb2021&utm_campaign=VitalSigns

High Blood Sugar leads to Brain Shrinkage, AAN

EMBARGOED FOR RELEASE UNTIL 4 PM ET, SEPTEMBER 3, 2012

Even in Normal Range, High Blood Sugar Linked to Brain Shrinkage

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MINNEAPOLIS – People whose blood sugar is on the high end of the normal range may be at greater risk of brain shrinkage that occurs with aging and diseases such as dementia, according to new research published in the September 4, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology.

“Numerous studies have shown a link between type 2 diabetes and brain shrinkage and dementia, but we haven’t known much about whether people with blood sugar on the high end of normal experience these same effects,” said study author Nicolas Cherbuin, PhD, with Australian National University in Canberra.

The study involved 249 people age 60 to 64 who had blood sugar in the normal range as defined by the World Health Organization. The participants had brain scans at the start of the study and again an average of four years later.

Those with higher fasting blood sugar levels within the normal range and below 6.1 mmol/l (or 110 mg/dL) were more likely to have a loss of brain volume in the areas of the hippocampus and the amygdala, areas that are involved in memory and cognitive skills, than those with lower blood sugar levels. A fasting blood sugar level of 10.0 mmol/l (180 mg/dL) or higher was defined as diabetes and a level of 6.1 mmol/l (110 mg/dL) was considered impaired, or prediabetes.

After controlling for age, high blood pressure, smoking, alcohol use and other factors, the researchers found that blood sugar on the high end of normal accounted for six to 10 percent of the brain shrinkage.

“These findings suggest that even for people who do not have diabetes, blood sugar levels could have an impact on brain health,” Cherbuin said. “More research is needed, but these findings may lead us to re-evaluate the concept of normal blood sugar levels and the definition of diabetes.”

The study was supported by the National Health and Medical Research Council Australia and the Australian Rotary Health Research Fund.

To learn more about the aging brain, visit http://www.aan.com/patients.

Source: http://www.aan.com/press/index.cfm?fuseaction=release.view&release=1100

Eccentric topic of the Week, Neurology Question 5

Eccentric topic of the Week, Neurology
Question 5:

Regarding the trochlear nerve: 

A. It originates from the midbrain

B. It is the only cranial nerve that exits from the dorsal surface of the brainstem
C. Its lesion results in paralysis of the inferior oblique muscle
D. It supplies only one orbital muscle
E. Its palsy causes horizontal diplopia

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