97 Questions
What is the typical pattern of neuronal injury observed in slower, progressive diseases like ALS or Alzheimer's disease?
Cell loss and reactive gliosis
What defines gemistocytic astrocytes in response to injury?
Hyperproliferative and hypertrophic astrocytes
How do activated microglial cells respond to injury?
They undergo morphological changes with fatter and shorter processes
Why is it often easier to observe gliosis compared to neuronal cell loss?
Cell loss occurs gradually over time in specific functional areas
What is the main reason for the subtle histologic findings associated with neuronal cell loss?
Cell loss usually occurs due to apoptosis without an inflammatory reaction
What is the role of gemistocytic astrocytes in response to injury?
Help with synaptogenesis after injury
What is a common early sign or symptom that can precede a migraine?
Unusual food cravings
Which visual symptom can occur during a migraine aura?
Blind spots with flashing lights
According to the diagnostic criteria for migraines, how long can a headache last during an attack?
Between 4 and 72 hours
Which of the following is a common characteristic of the pain experienced during a migraine attack?
Throbbing pain on one side of the head
What is NOT one of the POUND criteria used to screen for migraines?
Occipital location
Which symptom is NOT commonly associated with the aura phase of a migraine?
'Seeing stars'
What is a characteristic feature of non-communicating hydrocephalus?
Blockage of the cerebral aqueduct
Which symptom is more likely to be observed in the morning in patients with hydrocephalus?
Headaches
What is a common symptom in children with hydrocephalus associated with hypothalamic impairment?
Stunted growth
Which type of hydrocephalus is relatively common but very rare in individuals under 60 years old?
Normal pressure hydrocephalus
What distinguishes the pathogenesis of normal pressure hydrocephalus from other forms of hydrocephalus?
Impaired absorption at the arachnoid granulations
What physical sign is commonly associated with double vision in cases of hydrocephalus?
6th cranial nerve palsy
What is the primary role of CGRP in migraine pathophysiology?
Increasing pain sensation at the trigeminal ganglion
Which area of the brain is thought to be refractory to synaptic excitation after a spreading depression wave passes through?
Cortex
What is the main challenge in identifying candidate genes for migraine etiology?
Difficulty in targeting VG calcium channels
In migraine pathophysiology, what is the function of monoclonal antibodies that bind to CGRP?
Eliminate CGRP, preventing it from binding to its receptor
Which of the following is believed to lead to activation of the trigeminal complex in migraine pathophysiology?
Wave of spreading excitation in the cortex
What is the most accepted theory regarding the pathophysiology of 'other' neurologic findings in migraines?
'Spreading depression' wave linking to visual changes and aura findings
What is the most common feature of idiopathic intracranial hypertension?
Headache
What is the proposed pathogenesis of idiopathic intracranial hypertension?
Increased arterial inflow without corresponding venous outflow
Which of the following is NOT a common sign or symptom of idiopathic intracranial hypertension?
Seizures
Which of the following is the most effective treatment for idiopathic intracranial hypertension?
Weight loss
What is the most common type of herniation seen in increased intracranial pressure?
Tonsillar herniation
What is the hallmark feature of acute neuronal injury?
Eosinophilic cell bodies
Which of the following is NOT a common intracellular inclusion seen in neurological diseases?
Lipofuscin
What is the proposed mechanism of neuronal injury during cerebral ischemia?
All of the above
Which of the following is NOT a typical clinical feature of normal pressure hydrocephalus?
Seizures
What is the primary cause of hydrocephalus?
All of the above
Which type of migraine is characterized by the presence of an aura but no headache?
Acephalgic migraine
Which feature is NOT typically associated with a tension-type headache?
Throbbing pain and aggravation with movement
What is the maximum time interval between the onset of an aura and the start of a migraine headache?
60 minutes
Which of the following is a characteristic feature of complicated migraine?
Severe or persistent (reversible) sensorimotor deficits
Which of the following is NOT a common symptom associated with the aura phase of a migraine?
Nausea and vomiting
What is the most likely explanation for the increased muscle tension in tension-type headaches?
Unknown, but possibly related to stress or anxiety
Why would brain tissue deprived of blood flow (ischemia) become depolarized?
Lack of oxygen leads to decreased ATP production, which disrupts the sodium-potassium pump, causing membrane depolarization.
How could depolarization be linked to 'unregulated' neurotransmitter release?
Depolarization activates voltage-gated calcium channels, leading to an influx of calcium and triggering exocytosis of neurotransmitter-containing vesicles.
How can unregulated neurotransmitter release impact free radical production?
Unregulated neurotransmitter release leads to excitotoxicity, which activates NADPH oxidase and increases free radical generation.
What is the hallmark feature of acute neuronal injury, as described in the text?
Pyknosis, eosinophilic cell body, cell shrinkage, and loss of Nissl substance.
What is the proposed mechanism of neuronal injury during cerebral ischemia?
A combination of decreased ATP, membrane depolarization, and calcium influx.
Which of the following statements about primary and secondary headaches is correct?
Primary headaches are the disorder itself, while secondary headaches are caused by an underlying condition.
Which of the following is NOT a proposed mechanism for the pathogenesis of migraine headaches?
Chronic inflammation of the meninges.
Which of the following is a common cause of secondary headaches associated with elevated intracranial pressure?
Idiopathic intracranial hypertension.
Which of the following is a common feature of idiopathic intracranial hypertension?
Papilledema.
What is the proposed mechanism of action for monoclonal antibodies that bind to CGRP in the treatment of migraine headaches?
Blockade of CGRP-mediated vasodilation.
Which of the following statements about tension headaches is correct?
They are more variable in duration and less severe than migraines.
Which of the following is NOT a diagnostic criterion for cluster headaches?
Attacks must be accompanied by bilateral nasal congestion or rhinorrhea.
Which of the following best describes the pathogenesis of cluster headaches and trigeminal autonomic cephalalgias (TACs)?
They are caused by hypothalamic/circadian circuit dysregulation, with vasodilation as a result, not a cause.
Which of the following is NOT a characteristic feature of cluster headache attacks?
Autonomic symptoms are bilateral, not unilateral.
Which of the following structures is insensitive to pain and cannot cause headaches?
Brain parenchyma
Which of the following is a criterion for classifying a headache as low-risk?
The patient is younger than 30 years old.
Which of the following best describes the relationship between tension headaches and migraines?
Tension headaches and migraines are two distinct types of primary headaches.
Which of the following statements about secondary headaches is correct?
They have a clearly defined underlying cause, unlike primary headaches.
Which of the following statements about the pathophysiology of tension headaches is correct?
They are likely due to dysregulation of pain sensation in the central nervous system, with no clear pathophysiology yet.
Which of the following statements about the clinical features of tension headaches is NOT correct?
They are always accompanied by both photophobia and phonophobia.
Which of the following describes the proposed mechanism for increased intracranial pressure in idiopathic intracranial hypertension?
Subtle problems with venous sinus drainage and increased rate of arterial inflow exceeding venous outflow
What is the proposed mechanism by which glutamate contributes to neuronal injury during cerebral ischemia?
Glutamate overstimulates and causes persistent opening of NMDA receptors, allowing calcium influx.
Which of the following best describes the appearance of acute neuronal injury on H&E staining?
Neurons exhibit pyknosis, eosinophilic cell bodies, and loss of Nissl substance.
What is the primary function of gemistocytic astrocytes in response to injury?
To buffer excitotoxins, maintain the blood-brain barrier, and support neuron metabolism.
Which of the following best describes the role of activated microglial cells in response to injury?
They lose their processes, become ameboid, secrete cytokines, and phagocytose debris.
Which of the following best describes the pattern of neuronal injury in slower, progressive diseases like ALS or Alzheimer's disease?
Subacute/chronic neuronal degeneration with cell loss and reactive gliosis.
Which of the following best describes the mechanism by which a cell may depolarize during ATP depletion in ischemia?
Failure of the $Na^+/K^+$ ATPase pump leads to increased intracellular $Na^+$ and depolarization.
Which of the following best describes the role of astrocytes in mediating synaptogenesis and neurogenesis after injury?
The role of astrocytes in mediating synaptogenesis and neurogenesis remains controversial.
Which of the following best describes the primary cause of hydrocephalus?
Obstruction of cerebrospinal fluid flow or impaired reabsorption.
Why would brain tissue deprived of blood flow (ischemia) become depolarized?
Depletion of ATP due to lack of oxygen and nutrients results in failure of the Na+/K+ ATPase pump
How can unregulated neurotransmitter release impact free radical production?
Excess neurotransmitter stimulation can lead to increased intracellular calcium, which activates nitric oxide synthase and free radical generation
What is the hallmark feature of acute neuronal injury, as described in the text?
Pyknosis and eosinophilic cell body
How do activated microglial cells respond to injury?
Microglial cells proliferate and secrete inflammatory cytokines
What is the proposed mechanism of neuronal injury during cerebral ischemia?
Excitotoxicity from unregulated neurotransmitter release causes calcium overload and apoptosis
What is the primary difference between primary headaches and secondary headaches?
Primary headaches are the disorder itself, while secondary headaches are caused by an exogenous disorder.
Which of the following best describes the classification of a low-risk headache according to the text?
Headaches that are unlikely to cause significant pathology or harm.
What distinguishes normal pressure hydrocephalus from other forms of hydrocephalus?
The lack of enlarged ventricles in imaging studies.
What is a characteristic feature of the pain experienced during a migraine attack?
Dull throbbing pain that radiates throughout the head.
How do secondary headaches differ from primary headaches?
Secondary headaches are always associated with some underlying exogenous disorder.
What is the most common type of hydrocephalus that is relatively common but very rare in individuals under 60 years old?
Normal pressure hydrocephalus
Which of the following is NOT a typical clinical feature of normal pressure hydrocephalus?
Headache
What physical sign is commonly associated with double vision in cases of hydrocephalus?
Sixth cranial nerve palsy
In non-communicating hydrocephalus, what is an example of the type of obstruction that can cause the condition?
Blockage of the cerebral aqueduct
What is the primary cause of hydrocephalus?
Impaired absorption of cerebrospinal fluid at the arachnoid granulations
Which symptom is more likely to be observed in the morning in patients with hydrocephalus?
Vomiting
What is the primary mechanism by which transtentorial herniation can lead to life-threatening consequences?
Compression of the cerebral peduncles, causing bilateral hemiparesis
What is the primary concern with tonsillar herniation, a condition where the cerebellar tonsils are significantly displaced through the foramen magnum?
Compression of the brainstem, compromising vital respiratory and cardiac centers
Which of the following is a proposed mechanism of neuronal injury during cerebral ischemia (lack of blood flow)?
Excessive release of the excitatory neurotransmitter glutamate, leading to increased intracellular calcium levels
What is the proposed mechanism by which monoclonal antibodies that bind to CGRP (Calcitonin Gene-Related Peptide) can help in the treatment of migraine headaches?
Blocking the vasodilatory effects of CGRP, thereby reducing neurogenic inflammation
Which of the following best describes the role of activated microglial cells in response to injury in the central nervous system?
They release inflammatory mediators and can contribute to neuroinflammation and tissue damage
What is the proposed role of gemistocytic astrocytes in response to injury in the central nervous system?
They promote neuronal survival and support synaptogenesis and neurogenesis
Which key pathway is involved in the pain of migraine?
The trigeminovascular input from the meningeal vessels
What is the proposed mechanism of action for medications that act on the 5-HT1 receptors in the treatment of migraine?
They bind to serotonin (5-HT) receptors in the trigeminal nucleus and thalamus, modulating pain sensation.
Which of the following is NOT a typical clinical feature of migraine attacks according to the text?
Hypertension
What is the proposed role of the midbrain nuclei (dorsal raphe nucleus, locus coeruleus, and nucleus raphe magnus) in the pathophysiology of migraine?
They modulate the pain sensation from the trigeminal afferents, contributing to the abnormal pain sensation.
Which of the following statements about the epidemiology of migraine is correct according to the text?
Migraine affects 15% of men and 6% of women over a one-year period.
What is the proposed mechanism for the abnormal pain sensation in migraine related to vascular changes?
Abnormal pain sensation related to vascular dilation and constriction (vasomotion).
Test your knowledge on the patterns of neuronal injury, specifically focusing on subacute/chronic neuronal injury characterized by neuronal degeneration, cell loss, and reactive gliosis. Learn about diseases like ALS or Alzheimer's disease that exhibit slower, progressive neuronal damage.
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